Crystal's MCW Coder Hub2026 Coding and Payment Guide - Prostate Health
The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. They are thought to be relevant to Prostate Health procedures and are referenced throughout this document. We recommend consulting your relevant manuals for appropriate coding options. Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.
All rates shown throughout this guide are 2026 Medicare unadjusted national averages; actual rates will vary geographically and/or by individual facility. “Allowed Amount” is the amount Medicare determines to be the maximum allowance for any Medicare covered procedure. Actual payment will vary based on the maximum allowance, less any applicable deductibles, co-insurance, etc.
To determine whether there are relevant C-codes for any Boston Scientific products, please visit our C-code finder at http://www.bostonscientific.com/en-US/reimbursement/ccode-finder.html.
Physician Payment - Medicare Unadjusted National Average
| CPT® Code | Code Description | MD In-Facility Medicare Allowed Amount | Total Facility Based RVUs | MD In-Office Medicare Allowed Amount | Total Office Based RVUs |
|---|---|---|---|---|---|
| 52647 | Laser coagulation of prostate | N/A | N/A | N/A | N/A |
| 52648 | Laser vaporization of prostate | $528 | 15.82 | N/A | N/A |
| 52649 | Laser enucleation of prostate | $657 | 19.67 | N/A | N/A |
| 53854 | Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy | $354 | 10.6 | $3,398 | 101.73 |
| 55874 | Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed | $143 | 4.28 | $3,722 | 111.43 |
“N/A” indicates that Medicare has not deemed this procedure to be reimbursable in this setting.
Hospital Outpatient and ASC Payment - Medicare Unadjusted National Average
| CPT® Code | Code Description | APC | Hospital Outpatient Status Indicator | Hospital Outpatient Medicare Allowed Amount | ASC Medicare Allowed Amount |
|---|---|---|---|---|---|
| 52647 | Laser coagulation of prostate | N/A | D | N/A | N/A |
| 52648 | Laser vaporization of prostate | 5375 | J1 | $5,478 | $2,730 |
| 52649 | Laser enucleation of prostate | 5375 | J1 | $5,478 | $2,730 |
| 53854* | Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy | 5374 | J1 | $3,601 | $1,723 |
| 55874** | Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed | 5375 | J1 | $5,478 | $4,230 |
*C-Code may be applicable. See page 2 for more information. **Considered a device intensive procedure by CMS, SpaceOAR™ material must be reported with device code C1889, on the same claims form as the placement code.
Hospital Inpatient Payment - Medicare Unadjusted National Average
MS-DRG assignment is based on a combination of diagnoses and procedure codes reported. While MS-DRGs listed in this guide represent likely assignments, Boston Scientific cannot guarantee assignment to any one specific MS-DRG.
| MS-DRG | Description | Reimbursement |
|---|---|---|
| 713 | Transurethral prostatectomy with CC/MCC | $10,940 |
| 714 | Transurethral prostatectomy without CC/MCC | $7,694 |
The patient’s medical record must support the existence and treatment of the complication or co-morbidity.
ICD-10 CM Diagnosis Codes
| ICD-10 CM Diagnosis Code | Description |
|---|---|
| N40.0 | Enlarged prostate without lower urinary tract symptoms |
| N40.1 | Enlarged prostate with lower urinary tract symptoms |
| N40.2 | Nodular prostate without lower urinary tract symptoms |
| N40.3 | Nodular prostate with lower urinary tract symptoms |
| C61 | Malignant neoplasm of prostate |
ICD-10 PCS Procedure Codes
| ICD-10 PCS Procedure Code | Description |
|---|---|
| 0V508ZZ | Destruction of Prostate, Via Natural or Artificial Opening Endoscopic |
C-Code Information
For all C-Code information, please reference the C-code Finder: http://www.bostonscientific.com/en-US/reimbursement/ccode-finder.html.
| Code | OPPS Status Indicator | Description |
|---|---|---|
| C1889 | N (packaged)* | Implantable/insertable device, not otherwise classified |
*Source: https://www.cms.gov/license/ama?file=/files/zip/2026-nfrm-opps-addenda.zip
On claims for Medicare beneficiaries, hospitals should report not only the appropriate CPT® Code, but also all applicable C-Codes.
- It’s important that hospitals report C-Codes as well as the associated device costs as this will help inform and potentially increase future outpatient hospital payment rates.
Suggested Revenue Code for Device Codes C1889
| Code | Description |
|---|---|
| 278† | Medical/surgical supplies and devices/other implants |
CPT® Codes with Long Descriptions
| CPT® Code | Long Description |
|---|---|
| 52647 | Laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed) |
| 52648 | Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed) |
| 52649 | Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed) |
| 53854 | Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy |
| 55874 | Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed |
2025 Coding & Payment Quick Reference
Physician payment rates are 2026 Medicare national averages. Source: Centers for Medicare and Medicaid Services. CMS-1832-F, Physician Fee Schedule - Addendum B, Relative Value File October 2025 release, RVU24D file. https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-f
The 2026 National Average Medicare physician payment rates have been calculated using a 2026 conversion factor effective January 1, 2026, of $33.4009. Rates subject to change.
Hospital outpatient payment rates are 2026 Medicare OPPS Addendum B national averages. Source: Centers for Medicare and Medicaid Services. CMS OPPS - November 2025 release, CMS-1834-FC file. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1834-fc
ASC payment rates are 2026 Medicare ASC Addendum AA national averages. ASC rates are from the 2026 Ambulatory Surgical Center Covered Procedures List. Source: Centers for Medicare and Medicaid Services. CMS ASC November 2025 release, ASC Approved HCPCS Code and Payment Rates https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and-notices/cms-1834-fc
National average (wage index greater than one and hospital submitted quality data and is a meaningful EHR user) MS-DRG rates calculated using the national adjusted full update standardized labor, non-labor, and capital amounts. Source: August 4, 2025. Federal Register, CMS-1833-IFC. FY 2026 rates. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2026-ipps-final-rule-home-page
ICD-10 MS-DRG definitions from the CMS ICD-10-CM/PCS MS-DRG v42.0 Definitions Manual. Source: https://www.cms.gov/icd10m/FY2025-NPRM-Version42-fullcode-cms/fullcode_cms/P0001.html
† According to Medicare, devices do not need to remain in the body to be classified as “implants.”1,2
1 Preamble to the Inpatient Prospective Payment update regulation for FY 2009 (73 FR 48462).
2 Revenue Code 278 - Definition in UB-04 manual, National Uniform Billing Committee Summary, August 2009, Page 5: (a) Implantables: That which is implanted, such as a piece of tissue, a tooth, a pellet of medicine, or a tube or needle containing a radioactive substance, a graft, or an insert. Also included are liquid and solid plastic materials used to augment tissues or to fill in areas traumatically or surgically removed. An object or material partially or totally inserted or grafted into the body for prosthetic, therapeutic, diagnostic purposes. Examples of Other Implants (not all-inclusive): Stents, artificial joints, shunts, grafts, pins, plates, screws, anchors, radioactive seeds.