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US · guidance

CMS Pub. 100-04, ch. 32, § 180.1

Coverage Requirements

activein force · 2026-08-25 – presentas-observed

Medicare covers cryosurgery of the prostate gland effective for claims with dates of service on or after July 1,

1999. The coverage is for:

1. Primary treatment of patients with clinically localized prostate cancer, Stages T1 – T3 (diagnosis code is

185 – malignant neoplasm of prostate).

2. Salvage therapy (effective for claims with dates of service on or after July 1, 2001 for patients:

a. Having recurrent, localized prostate cancer;

b. Failing a trial of radiation therapy as their primary treatment; and

c. Meeting one of these conditions: State T2B or below; Gleason score less than 9 or; PSA less

than 8 ng/ml.

History

(Rev. 1111, Issued: 11-09-06, Effective: 04-01-07, Implementation: 04-02-07)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
0bf887568c2b39d46d148a6ef9c5c858bab3b4580335e83f3fdbdb8bfe9ffe32
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