Profound Medical Announces TULSA Reimbursement Raised to Urology APC Level 7 Under CMS Outpatient Prospective Payment System (OPPS) Final Rule for CY2025

Core Viewpoint - The U.S. Centers for Medicare and Medicaid Services (CMS) has established a Category 1 CPT® code for the Transurethral Ultrasound Ablation (TULSA) procedure, effective January 1, 2025, which positions TULSA as a leading treatment modality for prostate disease [1][4]. Group 1: CPT Codes and Reimbursement - TULSA will have three CPT codes based on the number of physicians involved: CPT 51721 for Device Management, CPT 55881 for Treatment with two physicians, and CPT 55882 for the Complete Procedure with one physician [2]. - All TULSA codes will have a 0-day global period, meaning that only the work performed on the day of the procedure is covered, allowing separate billing for pre- and post-procedure visits [2][8]. - The final rule has set the payment for TULSA CPT 55882 at $12,992 for Hospital Outpatient and $10,728 for Ambulatory Surgical Centers, representing increases of approximately 41% and 49% respectively compared to previous proposals [4]. Group 2: Clinical and Operational Aspects - TULSA codes are applicable across various treatment settings, including hospitals, ambulatory surgical centers, and private offices, enhancing accessibility for patients [3][5]. - The TULSA procedure is designed to be incision-free, with no blood loss and no hospital stay required, allowing for quick recovery and preservation of vital functions [5][11]. - The TULSA-PRO® system utilizes real-time MRI guidance and precise temperature control to effectively treat a range of prostate conditions while minimizing side effects [11]. Group 3: Relative Value Units (RVUs) - The total Facility RVUs for TULSA are set at 6.47 for CPT 51721, 14.56 for CPT 55881, and 17.91 for CPT 55882 when performed by one physician [6]. - For Non-Facility settings, RVUs are significantly higher, with 16.25 for CPT 51721, 263.05 for CPT 55881, and 272.21 for CPT 55882 [7]. - The TULSA procedure's 0-day global period contrasts with other prostate treatments that typically have a 90-day global period, which includes bundled payments for post-operative visits [8].