Aquablation therapy is a relatively new, noninvasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Medicare covers one treatment, but conditions apply.

Before having Aquablation (water ablation) therapy, it is essential to check that the treatment, equipment, medical facility, and healthcare professional are Medicare-approved and that the person meets the eligibility criteria.

This article explains who Medicare considers eligible for Aquablation therapy for BPH.

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Ablation means to destroy tissue. Aquablation, or water ablation, means using water to destroy tissue.

Aquablation therapy, also called waterjet hydrodissection or ablation, is a minimally invasive procedure that uses an unheated jet of saline water to remove enlarged prostate tissue without damaging surrounding tissue.

In this procedure, a doctor inserts an ultrasound probe into the rectum, enabling them to see the prostate gland. Next, they insert a long, narrow tube called a cystoscope into the bladder. Guided by ultrasound images, the doctor applies water pressure to reduce the amount of excess tissue.

Finally, the doctor will cauterize the tissue to stop it from bleeding.

Precise computer and robotic technology control the procedure, which takes less than 10 minutes.

BPH commonly affectsTrusted Source older males. In BPH, the prostate tissue overgrows, leading to symptoms such as increased urination, a weak urine stream, and feeling unable to empty the bladder fully, known as double voiding. Doctors use criteria such as the International Prostate Symptom Score (IPSS) to measure symptom severity.

Medicare defines Aquablation therapy for BPH as “a fluid jet system treatment of lower urinary tract symptoms attributable to benign prostatic hyperplasia (LUTS/BHP).”

Medicare Part B will cover Aquablation to treat urinary symptoms of BPH if all the following apply:

  • A transrectal ultrasound shows the prostate has a volume of 30 to 150 cubic centimeters (cc).
  • Symptoms are persistently moderate to severe, as indicated by:
    • an IPSS score of 12 or above
    • a maximum urinary flow rate of 15 milliliters (ml) per second or less
  • Drug treatments have not helped after 3 months, or they are unsafe for the person to use.

Medicare will only cover treatment if the medical device has approval from the Food and Drug Administration (FDA). Currently, only ProCept’s Aquabeam system has De Novo and 510k approval.

De Novo approval means that the company has performed the necessary trials and tests to ensure that the device is fit and safe for its proposed use. 510k approval means that the device is a suitable alternative to an existing medical device.

How many times will Medicare cover Aquablation therapy?

Medicare only covers one treatment with this therapy.

People are not eligible for Aquablation therapy under Medicare if they have already had one treatment or they:

Usually, the risks involved would be too high for people with these conditions.

The out-of-pocket cost of outpatient Aquablation is around $1,632. If a person undergoes this procedure in an ambulatory surgical center, it is around $1,240.

However, out-of-pocket costs for Aquablation will typically vary by medical facility or doctor. There may be additional costs for follow-up appointments, unforeseen hospital stays, or if complications arise.

The Aquablation Therapy website advises people to check that they are eligible for Medicare coverage and then, if the two are different, to check with their insurer, who can advise on expected out-of-pocket costs.

In 2023, researchers compared the cost of various BPH treatments based on Medicare reimbursements. They found that Aquablation was one of the most cost-effective options as long as it cost below $3,015. Cost-effectiveness considers the cost, the person’s quality of life per year, and life expectancy following the treatment.

Aquablation offers an alternative to transurethral resection of the prostate (TURP), an established long-term surgical option for BHP.

Before recommending either of these treatments, a doctor may consider medical options such as:

However, these options may not work for everyone, and a doctor or healthcare professional will work with individuals to find a treatment that works for them.

In 2023, some scientists concluded that a person who undergoes Aquablation rather than TURP may:

  • have better long-term symptom relief
  • be less likely to have ejaculatory dysfunction
  • have a lower IPSS score for up to 5 years
  • be less likely to need surgical or medical retreatment within 6 months

It is also faster and less invasive than TURP.

Aquablation only received FDA approval in 2017Trusted Source.

In 2018 and 2019, some experts expressed concern that it was too soon to be sure of the long-term effects compared with TURP. However, more recent research suggests it may be safer.

The risk of bleeding was the same after 6 months for both options, but the risk of complications overall was lower with Aquablation. The need for retreatment is also lower with Aquablation.

Aquablation is a relatively new treatment that can help relieve lower urinary tract symptoms due to BHP. Medicare will cover the cost of one treatment for people who meet the eligibility criteria.

In addition, the medical facility, doctor, and equipment must have Medicare approval.