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LCD L34090: Laser Ablation of the Prostate

LCD L34090, Laser Ablation of the Prostate, is the Local Coverage Determination that CGS Administrators, LLC applies to claims from 2 states (KY, OH), effective 2026-04-02 and first in force 2015-10-01. The policy text runs 396 words, and its billing and coding article A56467 lists 3 ICD-10-CM codes that support medical necessity for 2 procedure codes. No other contractor publishes a policy with this title.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: Medicare Coverage Database LCD export release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (Thursdays) for the MCD.
Contractor
CGS Administrators, LLC
States and territories
2
KY OH
Revision effective
2026-04-02
Original effective
2015-10-01
Policy text
396 words
Covered ICD-10 codes (articles)
3

Where this LCD applies

Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.

Contracts that apply LCD L34090
ContractContractorTypeStates
15102CGS Administrators, LLCMAC - Part BKY
15202CGS Administrators, LLCMAC - Part BOH
15101CGS Administrators, LLCMAC - Part AKY
15201CGS Administrators, LLCMAC - Part AOH

Billing and coding: diagnoses and procedure codes

Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56467 (Billing and Coding: Laser Ablation of the Prostate) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.

A56467: Billing and Coding: Laser Ablation of the Prostate (Billing and Coding, effective 2026-04-02)

Covered ICD-10-CM codes
3
1 group
Non-covered ICD-10-CM codes
0
Procedure codes listed
2
Full article
cms.gov record
First 3 covered ICD-10-CM codes in A56467
ICD-10-CMDescription (FY2027)
D29.1—
N40.1—
N40.3—

Procedure codes: 52648, 52649.

Coverage indications, limitations and medical necessity

Abstract:

Benign prostatic hyperplasia is an enlargement of the prostate gland that frequently occurs in men as they age. Current treatments include watchful waiting, medications i.e., alpha-blockers, and surgery. The gold standard for treating this condition is a transurethral resection of the prostate (TURP). Some patients may not be healthy enough to undergo this procedure and choose a less invasive procedure to treat this condition. This local coverage determination (LCD) addresses laser therapy of the prostate.

Laser prostatectomy, or visual laser ablation of the prostate (VLAP) is an alternative technique to the conventional surgical intervention of transurethral resection of the prostate (TURP) in treating bladder outlet obstruction caused by benign prostate hypertrophy (BPH).

Laser ablation of the prostate involves delivery of laser energy to the prostate in one of five main variations. These are: the transurethral ultrasound-guided laser-induced prostatectomy (TULIP), the free-fiber visually guided laser ablation of the prostate (VLAP), visually guided contact laser ablation of the prostate (CLAP), ultrasound guided interstitial laser coagulation of the prostate (ILCP), and the Holmium: YAG Laser (holmium laser ablation of the prostate -HoLAP, and holmium enucleation of the prostate - HoLEP).

Laser enucleation of the prostate using a high power laser source is performed on a small subset of patients requiring prostate surgery due to the enlarged size of the prostate. A laser fiber is used to undermine and dissect away large pieces of prostate tissue that migrate into the bladder and are subsequently extracted at the end of the procedure.

Indications:

Laser prostatectomy is indicated as a treatment modality for patients with bladder neck obstruction secondary to benign prostatic hyperplasia (BPH). Laser surgery provides some advantages over traditional TURP in that the hospital stay is decreased, patients can resume normal activities quicker and morbidity is reduced.

These procedures will be covered for the following indications:

• Duration of BPH 3 months or longer;

• American Urology Association (AUA) symptom score greater than 9 Urodynamics and Post-void Residual Volume examinations should be used as appropriate, e.g., patients with suspected neurologic disease or those who have failed prostate surgery.

Limitations:

A relative contraindication for these procedures is an active urinary infection.

The use of these devices must be prescribed and administered under the personal supervision of a qualified and trained physician, after appropriate urological evaluation of the patient. The treating physician must be present at all times during the treatment.

Summary of evidence (opening)

N/A

the full summary and analysis of evidence are in the CMS record.

Dates, lineage and related policies

Original determination effective
2015-10-01
Current revision effective
2026-04-02
Last reviewed by the contractor
2026-03-20
MCD version
22
Derived from
L31876

Using this policy on a claim

Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the CGS Administrators, LLC hub lists every other active policy from the same contractor.

Frequently asked questions

What does LCD L34090 cover?

Benign prostatic hyperplasia is an enlargement of the prostate gland that frequently occurs in men as they age. Current treatments include watchful waiting, medications i.e., alpha-blockers, and surgery. The gold standard for treating this condition is a transurethral resection of the prostate (TURP). Some patients may not be healthy enough to undergo this procedure and choose a less invasive procedure to treat… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.

Which states does LCD L34090 apply to?

CGS Administrators, LLC applies it to Medicare claims in KY, OH. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.

Which diagnosis codes support medical necessity under LCD L34090?

The companion billing and coding article A56467 lists 3 ICD-10-CM codes in 1 group that support medical necessity; the first 3 appear on this page and the complete list is in the article on cms.gov.

How do I appeal a denial under LCD L34090?

The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.