LCD Transurethral Waterjet Ablation of the Prostate - Effective December 14, 2025

Date Posted: October 30, 2025

This Local Coverage Determination (LCD) has completed the Open Public Meeting and Contractor Advisory Committee (CAC) comment period and is now finalized under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories). Responses to comments received may be found as a link at the bottom of the final LCD.

Medicare Coverage Database (MCD) Number/Contractor Determination Number: L38705

LCD Title: LCD Transurethral Waterjet Ablation of the Prostate - Effective December 14, 2025

Effective Date: December 14, 2025

Summary of LCD: Noridian Healthcare Solutions (NHS) along with other Medicare Administrative Contractors received a reconsideration request to revise the covered indication guidelines by removing the age requirement, prostate volume specifications determined by transrectal ultrasound, the need to void at least 125cc of urine and the exclusion criteria of patient with known or suspected prostate cancer, or a prostate specific antigen (PSA)>10 ng/mL unless the patient has a negative prostate biopsy within 6 months of treatment. Additionally, it was requested to remove limitations concerning bladder calculi and body mass index.

Visit the Proposed LCDs webpage to access this LCD.

Last Updated Oct 30 , 2025