REZUM code for insurance payments?

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I was going to have REZUM 2 weeks before Christmas ans then the Doctor told me that the insurance registry had cancelled the number used for the surgery and it would not pay for the surgery until they reestablish a new number for it. Could you chenck with your doctor and see what number they used for insurance reporting? Thanks

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  • Posted

    Q. How do you report the Rezum procedure?

    A. To report the Rezum procedure on medical claims, use CPT® code 53852 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy. The Rezum System uses radiofrequency energy to transform sterile water into stored thermal energy in the form of vapor, or steam. This water vapor is convectively delivered directly into the obstructive prostate tissue that causes BPH, where condensation releases enough thermal energy to denature the targeted prostate tissue cells to cause necrosis. The treated tissue is absorbed by the body's natural immune system. It is intended to relieve symptoms, obstruction, and reduce prostate tissue associated with benign prostatic hyperplasia (BPH). It is also indicated for treatment of prostates with hyperplasia of the central zone and/or a median lobe.

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    • Posted

      I just found out today that the CPT code you gave me is the old one that they no longer will use, sorry. I'll keep looking into it and see what and if they come out with a new one. 

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    • Posted

      Sounds about right, Cleoh.  I recognized that CPT code in your post, when I entered the following into Google:  "insurance code for REZUM procedure"  Finally, there were 34 million hits.

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  • Posted

    a. I would not trust insurance to pay for it if they don't have a CPT code right now, even if they say "it should be covered"

    b. I've been reading some reports of others who have done REZUM - sounds like some are very unhappy with results. Have you been following the discussion on rezum here on patient.info ?

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    • Posted

      My doctor has been doing it for about a year and it was covered by insurance but them they decided to look at it further and maybe give it a new code or something so we are waiting to see wha they assign to it. looks like the answer came form cleoh right above your reply. code is 53852.  I have been following the discussion and some of the people it has not helped had much more problems than I have. some have let their prostrate get too large for this to help and it is the only procedure out there that does not have any chance of ejackulation problems. I have read that those who end up with htat are really upset and dissatisfied now like going with the green laser way and TURP is really bad. hope this helps.I'll post again if I do the surgery and let you know if it does the job. God Bless.

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    • Posted

      I found out yesterday the CPT code of 53852 is the old one they no longer will accept. I'll keep looking for a new one.

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  • Posted

    It was probably not covered to begin with. Newer procedures which have not stood the test of time are excluded from patients policies as well as doctors malpractice insurance.
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    • Posted

      My doctor has done over 40 of the procedure and had it covered by Insurance ans then right before my surgery he told us they we re-evaluating it so they would not accept it for a time while they look at it.so insurance has been covering it for about a year now.
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    • Posted

      could be they were using a certain code to get it accepted, then the insurance company figured out what it actually was and it was costing them too much so they blocked it.
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    • Posted

      You might be correct. It cost about $4,500.00 without insurance so they might have decided to not allow it for now until lots of doctors start to scream. Maybe with Trump in and doing away with OBamacare things will change..
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    • Posted

      you can always dream - to get it approved I assume it has to be FDA approved, then get Insurance company Urologists who might be biased towards TURP to approve. I don't see how Obamacare has anything to do with it, unless they could code it as "gender reassignment" then it would be covered for sure! lololol

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    • Posted

      Yep. how funny. isn't that the way things go nowdays. Hopefully after he and his worthless helathcare program are gone some people with real brains will step in to get things to a better plan for all of us.

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    • Posted

      It wasn't exactly a joke - my company informed us that our premiums went up 30% partially to cover so called "sex transfomation operations and related services" Also up to $40,000 a year for "Adaptive Behavior Treatment" for children under 18 - so you  could argue that this operation would indeed be some kind of "sex transformation" right ?

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  • Posted

    I just had REZUM done today and it was covered by my insurance. I did confirmed coverage before I got it done and everything was covered. I don't have $4,500 anyway.

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