Aquablation Therapy Receives Category I Code in 2026 Medicare Proposed Physician Fee Schedule

PROCEPT BioRobotics’ Aquablation therapy received a Category I CPT code (52XX1), effective January 1, 2026, replacing the previous Category III code. The 2026 Medicare Proposed Physician Fee Schedule assigns 16.14 RVUs to Aquablation, translating to a $540 average payment, slightly exceeding TURP’s $529. This milestone reflects Aquablation’s clinical value and aims to broaden adoption by urologists, expanding patient access. Proposed payment rates are subject to a public comment period, with the Final Rule expected in November 2025.

“`html

PROCEPT BioRobotics (Nasdaq: PRCT) announced that its Aquablation therapy has been assigned a Category I CPT code (52XX1) effective January 1, 2026, replacing the current Category III code 0421T. The 2026 Medicare Proposed Physician Fee Schedule assigns 16.14 total RVUs to Aquablation therapy, translating to approximately $540 in national average payment, slightly higher than TURP’s 15.82 RVUs ($529).

This milestone recognition reflects Aquablation therapy’s clinical value and widespread adoption in BPH surgical treatment. The proposed payment rates are subject to a public comment period ending September 2025, with the Final Rule expected in November 2025.

PROCEPT BioRobotics (Nasdaq: PRCT) ha annunciato che la sua terapia Aquablation è stata assegnata un codice CPT di Categoria I (52XX1) a partire dal 1° gennaio 2026, sostituendo l’attuale codice di Categoria III 0421T. Il Proposta di Programma di Pagamento Medicare per i Medici del 2026 assegna 16,14 RVU totali alla terapia Aquablation, corrispondenti a circa 540 dollari di pagamento medio nazionale, leggermente superiore ai 15,82 RVU (529 dollari) della TURP.

Questo riconoscimento rappresenta un traguardo importante che riflette il valore clinico e la diffusione della terapia Aquablation nel trattamento chirurgico dell’IPB. Le tariffe di pagamento proposte sono soggette a un periodo di commenti pubblici che si conclude a settembre 2025, con la Regola Finale prevista per novembre 2025.

PROCEPT BioRobotics (Nasdaq: PRCT) anunció que su terapia Aquablation ha sido asignada un código CPT de Categoría I (52XX1) a partir del 1 de enero de 2026, reemplazando el actual código de Categoría III 0421T. El Programa Propuesto de Tarifas para Médicos de Medicare 2026 asigna 16.14 RVUs totales a la terapia Aquablation, lo que se traduce en aproximadamente $540 en pago promedio nacional, ligeramente superior a los 15.82 RVUs ($529) de la TURP.

Este reconocimiento representa un hito que refleja el valor clínico y la amplia adopción de la terapia Aquablation en el tratamiento quirúrgico de la HBP. Las tarifas de pago propuestas están sujetas a un período de comentarios públicos que finaliza en septiembre de 2025, con la Regla Final prevista para noviembre de 2025.

PROCEPT BioRobotics (나스닥: PRCT)는 자사의 아쿠아블레이션 치료법이 2026년 1월 1일부터 적용되는 카테고리 I CPT 코드(52XX1)를 부여받았으며, 기존 카테고리 III 코드 0421T를 대체한다고 발표했습니다. 2026년 메디케어 제안 의사 수가표는 아쿠아블레이션 치료에 총 16.14 RVU를 할당하며, 이는 전국 평균 약 540달러의 지급액에 해당하며, TURP의 15.82 RVU(529달러)보다 약간 높습니다.

이 중요한 인정은 아쿠아블레이션 치료가 전립선비대증 수술 치료에서 임상적 가치와 광범위한 채택을 반영함을 의미합니다. 제안된 지급률은 2025년 9월까지 공개 의견 수렴 기간을 거치며, 최종 규칙은 2025년 11월에 발표될 예정입니다.

PROCEPT BioRobotics (Nasdaq : PRCT) a annoncé que sa thérapie Aquablation se voit attribuer un code CPT de catégorie I (52XX1) à compter du 1er janvier 2026, remplaçant l’actuel code de catégorie III 0421T. Le barème proposé des honoraires des médecins Medicare 2026 attribue 16,14 RVU totaux à la thérapie Aquablation, ce qui correspond à un paiement moyen national d’environ 540 $, légèrement supérieur aux 15,82 RVU (529 $) de la TURP.

Cette reconnaissance marque une étape importante, reflétant la valeur clinique et l’adoption généralisée de la thérapie Aquablation dans le traitement chirurgical de l’HBP. Les tarifs proposés sont soumis à une période de consultation publique se terminant en septembre 2025, la règle finale étant attendue en novembre 2025.

PROCEPT BioRobotics (Nasdaq: PRCT) gab bekannt, dass seine Aquablation-Therapie ab dem 1. Januar 2026 einen Kategorie-I-CPT-Code (52XX1) erhält und damit den bisherigen Kategorie-III-Code 0421T ersetzt. Der vorgeschlagene Medicare-Physician-Fee-Schedule 2026 weist der Aquablation-Therapie insgesamt 16,14 RVUs zu, was einer nationalen Durchschnittszahlung von etwa 540 US-Dollar entspricht, etwas höher als die 15,82 RVUs (529 US-Dollar) der TURP.

Diese Anerkennung stellt einen wichtigen Meilenstein dar und spiegelt den klinischen Wert sowie die breite Akzeptanz der Aquablation-Therapie bei der chirurgischen Behandlung der BPH wider. Die vorgeschlagenen Zahlungsraten unterliegen einer öffentlichen Kommentierungsfrist bis September 2025, die endgültige Regelung wird für November 2025 erwartet.

Positive

  • Upgrade to Category I CPT code status validates clinical value and widespread adoption
  • Proposed payment rate of $540 is higher than TURP’s $529, supporting competitive positioning
  • New code status may facilitate broader surgeon adoption and patient access

Negative

  • Final payment rates subject to change after public comment period
  • Implementation delayed until January 1, 2026

Insights

Aquablation therapy’s upgrade to Category I CPT code signals mainstream acceptance and comparable reimbursement to standard TURP, boosting PROCEPT’s market position.

PROCEPT BioRobotics just secured a significant regulatory win with their Aquablation therapy receiving a Category I CPT code effective January 2026. This represents a crucial evolution from its current Category III code status. For context, Category III codes are temporary codes assigned to emerging technologies, while Category I codes indicate mainstream acceptance and established clinical efficacy.

The assigned 16.14 total RVUs (Relative Value Units) translate to approximately $540 in Medicare reimbursement, slightly higher than the 15.82 RVUs ($529) assigned to TURP (Transurethral Resection of Prostate), which has long been the standard surgical treatment for BPH (Benign Prostatic Hyperplasia).

This reimbursement parity with TURP is particularly noteworthy as it removes a key barrier to adoption. Historically, physicians face financial disincentives when adopting new technologies that are reimbursed at lower rates than established procedures. With comparable reimbursement, the decision to use Aquablation can now be based primarily on clinical factors rather than economic ones.

The timing of this announcement gives stakeholders visibility into future payment structures well before implementation. While the final rule won’t be released until November 2025 following the comment period, the proposed rates signal CMS’s recognition of Aquablation’s clinical value in the BPH treatment landscape.

This regulatory milestone strengthens PROCEPT’s commercial position by facilitating broader adoption among urologists and expanding access for Medicare beneficiaries seeking surgical treatment for BPH with potentially fewer sexual side effects than traditional approaches.

07/14/2025 – 09:15 PM

SAN JOSE, Calif., July 14, 2025 (GLOBE NEWSWIRE) — PROCEPT BioRobotics® Corporation (Nasdaq: PRCT) (the “Company”), a surgical robotics company dedicated to advancing patient care through transformative urology solutions, today announced that Aquablation therapy was assigned a Category I code effective January 1, 2026.

The 2026 Medicare Proposed Physician Fee Schedule (PFS) includes payment rates for a new Category I Current Procedural Terminology (CPT) code related to Aquablation therapy. Category I CPT code 52XX1 will replace Category III CPT code 0421T as the primary code for Aquablation therapy.

“Securing a Category I CPT Code marks a major milestone for PROCEPT, the urology community, and the patients we serve,” said Sham Shiblaq, chief commercial officer of PROCEPT BioRobotics. “This transition recognizes the clinical value and widespread use of Aquablation therapy as we continue to make progress toward becoming the BPH surgical standard of care. The Category I code will further support surgeon adoption and broaden patient access to a treatment that delivers durable symptom relief with a low risk of sexual side effects.”

The new CPT Category I Code 52XX1 was assigned a 2026 national Medicare physician proposed payment of 16.14 total RVUs which translates to an approximate national average of $540, under the 2026 proposed Medicare PFS. By comparison, TURP was assigned 15.82 total RVUs which translate to an approximate national average of $529.

The PFS Proposed Rule was released on July 14, 2025, and updated payment policies and payment rates for services will be provided for Medicare beneficiaries on or after January 1, 2026. The Proposed Rule release is followed by a public comment period that will close in September 2025 and will culminate in CMS’ release of the Final Rule, which is expected to be announced in November 2025 for implementation on January 1, 2026. The Proposed Rule is therefore subject to change.

These 2026 proposed rule payment values and RVU assignments can be viewed on the CMS website at: https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-p

About Aquablation Therapy
Aquablation therapy is the first and only ultrasound guided, robotic-assisted, heat-free waterjet for the treatment of BPH. The system’s real-time ultrasound imaging provides the surgeon with a multi-dimensional view of the prostate enabling personalized treatment planning tailored to each patient’s unique anatomy. The surgeon can specify which areas of the prostate to remove while preserving the anatomy that controls erectile function, ejaculatory function and continence. Once the treatment plan is mapped by the surgeon, the predictable robotic-assisted execution enables prostate tissue to be removed in a precise, targeted and controlled fashion.

About PROCEPT BioRobotics Corporation
PROCEPT BioRobotics is a surgical robotics company focused on advancing patient care by developing transformative solutions in urology. PROCEPT BioRobotics manufactures the AQUABEAM® and HYDROS™ Robotic Systems. The HYDROS Robotic System is the only AI-powered, robotic technology that delivers Aquablation therapy. PROCEPT BioRobotics designed Aquablation therapy to deliver effective, safe, and durable outcomes for males suffering from lower urinary tract symptoms or LUTS, due to BPH that are independent of prostate size and shape or surgeon experience. BPH is the most common prostate disease and impacts approximately 40 million men in the United States. The Company has developed a significant and growing body of clinical evidence with over 150 peer-reviewed publications, supporting the benefits and clinical advantages of Aquablation therapy.

Forward-Looking Statements
This press release may contain forward-looking statements within the meaning of federal securities laws. Forward-looking statements are subject to numerous risks and uncertainties that could cause actual results to differ materially from those anticipated or implied in such statements. PROCEPT BioRobotics undertakes no obligation to publicly update or revise any forward-looking statements.

Important Safety Information
All surgical treatments have inherent and associated side effects. For a list of potential side effects visit https://aquablation.com/safety-information/

Aquablation Therapy Receives Category I Code in 2026 Medicare Proposed Physician Fee Schedule
Aquablation Therapy Receives Category I Code in 2026 Medicare Proposed Physician Fee Schedule

FAQ

What is the new Category I CPT code assigned to PRCT’s Aquablation therapy?

The new Category I CPT code 52XX1 will replace Category III code 0421T for Aquablation therapy, effective January 1, 2026.

How much will Medicare reimburse for PRCT’s Aquablation therapy under the 2026 proposed fee schedule?

Under the 2026 proposed Medicare Physician Fee Schedule, Aquablation therapy is assigned 16.14 RVUs, translating to approximately $540 in national average payment.

How does PRCT’s Aquablation therapy reimbursement compare to TURP?

Aquablation therapy’s proposed reimbursement ($540) is slightly higher than TURP’s reimbursement ($529), with 16.14 RVUs compared to TURP’s 15.82 RVUs.

When will PRCT’s new Aquablation therapy Category I CPT code take effect?

The new Category I CPT code will take effect on January 1, 2026, following the Final Rule announcement expected in November 2025.

What is the significance of PRCT receiving a Category I CPT code for Aquablation therapy?

The Category I code status represents recognition of Aquablation therapy’s clinical value and widespread use, potentially supporting broader surgeon adoption and patient access to treatment.

“`

Original article, Author: Jam. If you wish to reprint this article, please indicate the source:https://aicnbc.com/4751.html

Like (0)
Previous 9 hours ago
Next 7 hours ago

Related News