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Head Office
Profound Medical Corp.,
2400 Skymark Avenue,
Unit #6, Mississauga, ON L4W 5K5, Canada
T: 647.476.1350
F: 647.847.3739
info@profoundmedical.com
REIMBURSEMENT STATEMENT
Payor policies vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements. The coding options listed within the reference guide/s are commonly used codes and are not intended to be an all-inclusive list. This information is presented for illustrative purposes only and does not constitute legal or reimbursement advice. It is always the provider’s responsibility to determine medical necessity and submit appropriate codes, modifiers and charges for services rendered appropriate to the site of service in which the procedure is furnished. We recommend consulting relevant manuals for appropriate coding options and the payor for coding guidance.
TULSA-PRO 2025 Codes and Medicare Payment Rates
The TULSA-PRO® System uses a transurethral ultrasound applicator for ultrasound ablation of prostate tissue under continuous magnetic resonance (MR) guidance and control. This FDA-cleared device (cleared 2019) is indicated for transurethral ultrasound ablation (TULSA) of prostate tissue. The procedure can be performed in the Hospital Outpatient setting, an Ambulatory Surgery Center (ASC) or an Office Based Laboratory (OBL), commonly known as Physician Office .
Three new Category I CPT codes have been added for 2025 for CPT Professional Fee Schedule and as part of the Medicare Fee Schedules.
These three codes are :
| HCPCS/CPT Code | Description |
|---|---|
| 51721-TULSA Device Management (when done by two physicians) | Insertion of transurethral ablation transducers for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed |
| 55881-TULSA Treatment (when done by two physicians) | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation |
| 55882-TULSA Complete Procedure (when done by single physician) | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed |
The TULSA-PRO facility reimbursement when performed in the Outpatient or ASC are categorized as APC 5377, Urology Level 7 .
| APC Level 7 Urology | Hospital Outpatient (HOPD | Ambulatory Surgical Center (ASC) | |
|---|---|---|---|
| TULSA Complete Procedure: 55882 Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed | 5377 | $12,992.42 | $10,728.00 |
CPT code 51721 and CPT code 55881 should be billed together when two physicians perform the different components of the procedure-51721 for the Device Management work and 55881 for the Ablation of the prostate tissue. CPT code 55882 should be used when one physician performs the entire procedure. These codes go into effect January 1, 2025.
Medicare Payment Rates for 2025
The tables below show the Medicare physician Relative Value Units (RVUS) and payment rates for the TULSA-PRO when performed in a facility (Outpatient Hospital or ASC) and in an office-based lab (OBL).
All three codes have 0-day global periods meaning that all post-operative care and office visits after the day of surgery is separately billable. Other Prostate cancer interventions such as Radical Prostatectomy, HIFU, and Cryoablation all have 90-day periods where post-operative visits and post-operative care done in the first 90-days are included in the RVUs and payment rates
Outpatient Hospital or ASC
| HCPCS Code | Description | Total RVUS | Payment* |
|---|---|---|---|
| Two Physicians | |||
| 51721 | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed | 6.47 | $209 |
| 55881 | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed | 14.56 | $471 |
| Total | 21.03 | $680 | |
| One Physician | |||
| 55882 | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed | 17.91 | $579 |
| *National averages only and do not reflect RVU geographic practice cost adjustments. | |||
Physician Office (Office Based Lab-OBL)
| HCPCS Code | Description | Total RVUS | Payment* |
|---|---|---|---|
| Two Physicians | |||
| 51721 | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed | 16.25 | $526 |
| 55881 | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed | 263.05 | $8509 |
| Total | 279.30 | $9035 | |
| One Physician | |||
| 55882 | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed | 272.21 | $8,806 |
| *National averages only and do not reflect RVU geographic practice cost adjustments. | |||
The TULSA-PRO facility reimbursement when performed in the Outpatient or ASC are categorized as APC 5377, Urology Level 7 . TULSA-PRO is the only prostate intervention at this APC-7 payment level, all others are in lower payment levels. The table below shows the payment levels for common prostate interventions
| Procedure | CPT Code | Global Period | 2025 APC Level | 2025 Hospital HOPD Payment | 2025 ASC Payment | 2025 Non-Facility OBL RVU | 2025 Non-Facility OBL Dollar $ |
|---|---|---|---|---|---|---|---|
| TULSA | 55882 | 0 Day | 5377, Urology Level 7 | $12,992 | $10,728 | 272.21 | $8,806 |
| Robotic RP | 55866 | 90 Day | 5362, Laparoscopy Level 2 | $10,411 | N/A | N/A | N/A |
| Aquablation | 0421T | 90 Day | 5376, Urology Level 6 | $9,247 | $6,756 | Contractor Priced | N/A |
| HIFU | 55880 | 90 Day | 5376, Urology Level 6 | $9,247 | $4,780 | N/A | N/A |
| Cryo | 55873 | 90 Day | 5376, Urology Level 6 | $9,247 | $6,965 | 163.03 | $5,273 |
| TURP | 52601 | 90 Day | 5375, Urology Level 5 | $5,084 | $2,522 | N/A | N/A |
| Rezum/BPH | 53854 | 90 Day | 5374, Urology Level 4 | $3,449 | $1,336 | 47.95 | $1,551 |