Criteria not met
Routing
UHC Direct (commercial)
MRI Sequencing
MRI must be submitted to eviCore FIRST with 'Pre-surgical planning for BPH - Aquablation'
CPT Code
52597 (DOS 2026-03-15)
Diagnosis
N40.1 (BPH with LUTS)
Concordance - IPSS
IPSS 15 (Moderate, >= 13)
Concordance - Qmax
Qmax 10 mL/s (<= 15, obstructed)
Concordance - Volume
Volume 60 mL (30-150 range)
Concordance - All 4 Vectors
All vectors aligned
PSA / Cancer
PSA 3.5 (< 10)
Conservative Care
No alpha-blocker trial (4-6 weeks required)
Contraindications
No absolute contraindications
Bundling Check
No bundled codes
Site of Service
ASC (UHC preferred default)
Revenue at Risk
$24,200
Annual Impact (est.)
$363,000
Based on estimated annual procedures at current denial rates. Actual impact varies by volume and payer mix.
Want deeper analysis?
Full Intelligence Report: CPT 52597
