HIFU coverage
HIFU coverage refers to insurance benefits that pay for high-intensity focused ultrasound procedures, which treat conditions like prostate cancer. Most private insurers in the US, such as Aetna and UnitedHealthcare, classify HIFU as experimental and deny routine coverage.
Medicare covers HIFU for prostate tissue ablation under CPT code 55880 since January 2021 but restricts payment to specific clinical indications. Blue Cross Blue Shield plans in states like California exclude HIFU from standard benefits unless medical necessity is proven through peer-reviewed studies.
Out-of-pocket costs for uninsured HIFU patients average $15,000–$25,000 per procedure at centers including Mayo Clinic and Cleveland Clinic. Insurers require prior authorization before approving any HIFU claim submission, according to a report from YourInsurance.info.
Appeals processes exist if an insurer denies a pre-authorization or claim for HIFU treatment based on lack of FDA-approved indications. Coverage policies update annually; recent changes reflect expanded use only when supported by randomized controlled trial data published in journals such as JAMA Oncology.
Is HIFU for prostate cancer covered by insurance?
Yes, hifu for prostate cancer is often covered by insurance. Insurance coverage varies depending on the individual’s provider and policy. Most major insurers in the US provide coverage for hifu treatments, although some may require prior authorization or referrals before approval of benefits. Many states have mandated insurance coverage for certain aspects of prostate cancer…
See also HIFU insurance coverage, and High blood pressure.