PROCEPT BioRobotics is committed to supporting healthcare professionals and patients to navigate the insurance process. The site contains information and resources that you may need throughout the process.
Two of the major national private insurance companies (Anthem and Humana) have issued positive coverage policies for its patients. For all other private insurance companies, coverage can be assessed on an individual basis, and you should speak with your provider directly to determine if Aquablation therapy is available for you.
Medicare has issued final positive coverage policies covering Aquablation therapy for Medicare and Medicare Advantage patients in the United States. Effective November 2020, positive coverage policies were available in the following 12 states: Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, Wisconsin, Kentucky and Ohio. Positive coverage policies for the remaining 38 states are effective December 2020.
The Aquablation Reimbursement Center (ARC) is a case-by-case reimbursement support service program for physicians and providers who perform Aquablation procedures. ARC Reimbursement services include:
- Answers to general questions about coding, coverage, and payment
- Submission for prior authorization
- Facilitation of claims appeal submission
We will post any coverage updates from private insurance companies on our website, so check back frequently. If you have any questions, please don’t hesitate to contact us directly.
Private insurers may require prior authorization for Aquablation Therapy. Medicare does not require prior authorization for Aquablation Therapy.
ARC supports providers with private payer prior authorizations.
Denials And Appeals
Patients and providers have the right to appeal prior authorization denials, claim denials and insufficient payment. Each payer has a defined appeals process. Appeals ensure that patient claims are given appropriate consideration and review. Claim appeals also address payer non-coverage.
ARC supports physician offices with the appeal process.
Reimbursement and coverage vary by geography in markets outside the United States. We recommend patients contact their local physician providers to determine if Aquablation therapy is available.
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 payor. 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.
All surgical treatments have inherent and associated side effects. The most common side effects are mild and transient and may include mild pain or difficulty when urinating, discomfort in the pelvis, blood in the urine, inability to empty the bladder or a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum where the devices gain access to the body for treatment. For more information about potential side effects and risks associated with Aquablation therapy for Benign Prostatic Hyperplasia (BPH) treatment, speak with your urologist or surgeon. No claim is made that the AquaBeam Robotic System will cure any medical condition, or entirely eliminate the diseased entity. Repeated treatment or alternative therapies may sometimes be required.