Insurance
PROCEPT BioRobotics is committed to supporting healthcare professionals and patients in navigating the insurance process. The site contains information and resources that you may need throughout the process.
UNITED STATES
Aquablation therapy is considered a covered benefit for Medicare and Medicare Advantage beneficiaries when medical criteria are met. In addition, most of the major national private insurance companies have issued positive coverage policies regarding Aquablation therapy for their patients. This includes, but is not limited to, Aetna, Anthem, Cigna, Humana and UnitedHealthcare. Most Blue Cross Blue Shield and other regional insurance companies also cover the procedure.
However, there is no guarantee of insurance coverage for a particular procedure or product. It is the responsibility of the patient to work with their physician and insurance provider for specific coverage information.
We recommend a verification of benefits be done with your insurance company in advance of Aquablation therapy. This is an important step towards understanding the coverage under your insurance plan. Your insurance provider may require a Prior Authorization and/or allow for a Pre-Determination. These processes are meant to allow your health insurance company the opportunity to evaluate your treatment plan and specifics of the request to review for medical necessity. Please discuss with your physician’s office about your anticipated coverage options.
If you have any questions, please don’t hesitate to contact us.
INTERNATIONAL
Reimbursement and coverage varies from country to country. For example, Aquablation therapy is available for patients under “Standard Arrangement” in the United Kingdom – NICE’s most positive recommendation. Aquablation therapy is also available for patients covered by Japan’s national health insurance system.
We recommend patients contact their physician to determine if Aquablation therapy is available in their country.
Disclaimer: This information is provided by PROCEPT BioRobotics for illustrative purposes only and does not constitute legal or reimbursement advice. The information provided on this website is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. All content is general in nature and does not cover all situations or all payers’ rules and policies. It is the responsibility of the hospital or physician to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, modifiers, and charges for a particular patient and/or procedure. PROCEPT BioRobotics encourages providers to submit claims for services consistent with FDA clearance and approved labeling.
Hospitals and physicians should consult with appropriate payers, including Medicare Administrative Contractors, reimbursement specialists, and/or legal counsel for specific information on proper coding, billing, and payment levels for healthcare procedures. PROCEPT BioRobotics makes no express or implied warranty or guarantee regarding any determination or payment amount by any payer. PROCEPT BioRobotics makes no specific promise or guarantee that the ARC will provide any or all of the services listed above in any particular case.