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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

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Ablative Therapy of Renal Lesions
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Cryosurgery of Prostate
Medicare
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Laser Ablation of the Prostate
Medicare
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Outpatient Cystourethroscopy
Anthem
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Posterior Tibial Nerve Stimulation (PTNS) for Voiding Dysfunction
Medicaid
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Prostate Surgical Interventions
UHC
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Posterior Tibial Nerve Stimulation (PTNS) for Voiding Dysfunction
Medicaid
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Urethroplasty
UHC
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Vasectomy Procedures
Aetna
Indicates Non-covered Service
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Artificial Intelligence-Based Software for Prostate Cancer Detection
Anthem
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Prostate Saturation Biopsy
Anthem
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Benign Prostatic Hypertrophy (BPH) Treatments
Aetna
Anthem
Cigna
Humana
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Enhanced Cystoscopy for Bladder Cancer
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Male Urethral Sling
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Penile Circumcision
Anthem
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Prostate Cancer Screening
Aetna
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Prostatectomy
Humana
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Transrectal Ultrasound
Anthem
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Urinary Bladder Dysfunction Treatment
Humana
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Water Vapor Thermal Therapy for LUTS/BPH
Medicare
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Focal Laser Ablation for the Treatment of Prostate Cancer
Anthem
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Radiofrequency Ablation Renal Sympathetic Nerves
Anthem

Urology

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Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds
Humana
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Extracorporeal Shock Wave Lithotripsy (ESWL)
UHC
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Erectile Dysfunction Diagnosis & Treatment
Aetna
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Penile Prosthesis Implantation
Anthem
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Prostate Rectal Spacers
Medicare
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Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift)
Medicare
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Transurethral Waterjet Ablation of the Prostate
Medicare
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Urinary Incontinence Treatment
Aetna
Anthem
Medicaid
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Whole Gland Cryoablation of Prostate Cancer
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Interstitial Motexafin Lutetium-mediated Photodynamic Therapy for Prostate Cancer
Aetna
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Transvaginal Radiofrequency Bladder Neck Suspension & Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence
FloridaBlue
FloridaBlue
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Circumcision - Medical indications
UHC
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Gender Reassignment Surgery
penileprosthesis.jpg
Male Sexual Dysfunction Treatment: Nonpharmacologic
Cigna
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Periurethral Injections of Bulking Agents
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Prostate-Specific Antigen (PSA) Screening for Prostate Cancer
Cigna
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Scrotal Ultrasonography
Aetna
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Treatment of Kidney Stones
Medicare
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Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia (CMS771v3)
cryoblationprostate.jpg
Nerve Graft after Prostatectomy
Anthem
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Collagenase clostridium histolyticum (Xiaflex ®)
Anthem
Cigna
FloridaBlue
UHC
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High Intensity Focused Ultrasound (HIFU)
Aetna
Cigna
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Multiparametric Magnetic Resonance Fusion Imaging Targeted Prostate Biopsy
urethrabulking.jpg
Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents
Aetna
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Prostate Biopsy
Aetna
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Surgical & Invasive Treatments for Overactive Bladder
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UHC Outpatient Surgical Procedures - Site of Service Criteria: Male Genital System
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Urodynamics
Medicare
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PCR Testing-UTI Panels
Cigna
cryoblationprostate.jpg
Cryoablation of the Prostate
Aetna
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Hydrocelectomy
UHC
urethrabulking.jpg
Neurogenic Bladder Treatment
Aetna
ptns.jpg
Percutaneous Tibial Nerve Stimulation
FloridaBlue
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Prostate Biopsy using MRI Fusion Techniques
Anthem
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Surgical & Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
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UHC Outpatient Surgical Procedures - Site of Service Criteria: Urinary System
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Uroflowmetric Evaluations
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Pelvic Floor Stimulation as a Treatment of Incontinence
FloridaBlue
Indicates Non-covered Service
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Incision & Drainage of Abscess of Skin, Subcutaneous & Accessory Structures
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Nocturnal Enuresis Treatments
Aetna
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Sacral Nerve Stimulation & Percutaneous Tibial Nerve Stimulation for Urinary & Fecal Incontinence; Urinary Retention
Anthem
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Prostate Saturation Biopsy
FloridaBlue
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Ureteroscopy
UHC
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Varicocele Treatment
Aetna
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Prostate Mapping Biopsy
Anthem
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