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The TULSA Procedure, an innovative and minimally invasive prostate treatment, has received groundbreaking recognition under the U.S. Centers for Medicare and Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS) for 2025. This significant update elevates TULSA to Urology Ambulatory Payment Classification (APC) Level 7, making it the highest reimbursed prostate treatment in its category.
What is the TULSA Procedure?
The TULSA Procedure (Transurethral Ultrasound Ablation) offers an incision-free, MRI-guided ultrasound ablation of prostate tissue, including cancer and benign prostatic hyperplasia (BPH). Using ultrasound energy to ablate targeted tissue while preserving surrounding structures, TULSA-PRO provides a precision-driven alternative to traditional surgeries.
Understanding APC Levels
APC levels are used by CMS to group medical procedures based on complexity and the resources required. This categorization determines reimbursement rates for healthcare facilities. TULSA-PRO’s placement in Urology APC Level 7—the highest level in this category—sets it apart from other prostate treatments.
Significance of Urology Level 7 APC Classification
APC levels categorize medical procedures based on the complexity and resources required, influencing reimbursement rates. TULSA-PRO’s placement at Level 7 sets it apart as the first and only prostate treatment to achieve this status.
- Higher Reimbursement in Hospitals: TULSA-PRO now commands a Medicare national average hospital reimbursement of $12,992. This rate is over 40% higher than treatments in Urology Level 6, such as Aquablation and HIFU, and 25% higher than robotic prostatectomy.
- Increased ASC Reimbursement: For Ambulatory Surgical Centers (ASCs), TULSA offers a Medicare national average reimbursement of $10,728—a 31% increase from previous rates and nearly 60% higher than other Level 6 treatments.
This elevated reimbursement reflects TULSA’s clinical and economic value in the medical community.
How TULSA-PRO Compares to Other Prostate Treatments
- Urology Level 6: Treatments like Aquablation, High-Intensity Focused Ultrasound (HIFU), and Cryotherapy.
- Urology Levels 5 and 4: Procedures like Transurethral Resection of the Prostate (TURP) and Rezum.
- Robotic Prostatectomy: Slightly higher than Urology Level 6 but still below TULSA’s Level 7 classification.
TULSA-PRO now leads in facility reimbursement, with a Medicare national average payment of $12,992 for hospital outpatient departments—over 40% higher than Level 6 treatments and 25% higher than robotic prostatectomy, which traditionally involves more complex infrastructure and resources.
Flexibility in Physician Office Settings
Unlike most advanced prostate treatments, TULSA-PRO can be performed in Medicare-recognized physician offices (Office-Based Labs or OBLs). This versatility allows patients to choose a treatment setting that fits their needs, improving access and convenience.
First-Ever CPT® Category I Codes for TULSA
Significance of CPT® Category I Codes
The introduction of CPT® Category I codes for TULSA-PRO marks a breakthrough for MRI-guided focused ultrasound surgery (MRgFUS) in prostate care. These codes reflect widespread clinical acceptance and enable streamlined provider billing and reimbursement.
TULSA vs. InSightec Neuro Procedure
TULSA-PRO’s CPT® Category I codes will take effect on January 1, 2025, ahead of InSightec’s Neuro procedure, which is set to receive similar recognition later that year. Notably, TULSA-PRO’s hospital reimbursement rate of $12,992 slightly exceeds that of the Neuro procedure, emphasizing its growing recognition in the medical community.
Why This Matters for Patients and Providers
The advancements in reimbursement and coding for TULSA-PRO translate to improved accessibility and care options:
- Flexible Treatment Settings: TULSA-PRO can now be performed in hospitals, ASCs, and physician offices, making it one of the most versatile prostate cancer treatments available.
- Economic Benefits: Its higher reimbursement rates incentivize healthcare providers to adopt TULSA-PRO, bringing cutting-edge technology to more facilities.
- Enhanced Patient Outcomes: The minimally-invasive TULSA Procedure has reduced side effects, improving the quality of life for patients.
Looking Ahead
TULSA-PRO receiving Urology Level 7 APC and its CPT® Category I coding mark a pivotal moment in prostate cancer treatment. These milestones not only validate TULSA-PRO’s clinical effectiveness but also pave the way for broader adoption across diverse healthcare settings.
To learn more about the TULSA Procedure and its applications, visit the TULSA Procedure page.
Jun 3, 2025 | Team iNet