Profound Medical announces CMS established Category 1 CPT for TULSA procedure

Profound Medical (PROF) announced that U.S. Centers for Medicare and Medicaid Services, or CMS, has released its final rule establishing, for the first time, a Category 1 CPT code for the Transurethral Ultrasound Ablation, or TULSA, procedure, effective January 1, 2025. According to the Final Rule, TULSA will have three codes to cover how therapy is delivered depending on if there are one or two physicians involved in the procedure: CPT 51721 TULSA Device Management and CPT 55881 TULSA Treatment, when two physicians are involved in the procedure, and CPT 55882 TULSA Complete Procedure, when performed by a single physician. All three TULSA codes will have a 0-day global period, indicating that the payment associated with the codes will only cover the work performed on the day TULSA is performed. Physicians will thereby bill for any pre- or post-procedure patient visits separately using existing evaluation and management (E/M) codes. This will provide physicians with the most flexibility to assess the appropriate number of visits needed by each patient and enable their safe and fast recovery. Uniquely for prostate treatment modalities, TULSA codes have been assigned to all three sites of service: Hospital Outpatient, Ambulatory Surgical Center, and Private Office/Non-Facility. The spectrum of the location of service will ensure TULSA patients can be treated in an unrivalled number of settings. For Hospital Payment, the Final Rule has established TULSA CPT 55882 as a Level 7 Urology Ambulatory Payment Classification for 2025 of $12,992. For ASCs, the facility payment for CPT 55882 will be $10,728. This represents increases of approximately 41% and 49% for hospitals and ASCs, respectively, over TULSA payments previously set in the Proposed Rule announced in July and is also 25% higher than the Final Rule for robotic radical proctectomy, a mainstream treatment modality for prostate cancer, and 41% higher than the 2025 payment classification for benign prostatic hyperplasia (“BPH”) treatments, such as Aquablation.