How CMS Proposed Rule May Benefit Some Practices That Treat BPH

CMS Proposed Rule Benefits Summary

The proposed CMS rule for the upcoming year presents an unusual circumstance that appears to differentially benefit smaller private practices while potentially disadvantaging colleagues compensated based on work RVUs. The rule creates a redistribution effect by reducing work RVU values for several benign prostatic hyperplasia (BPH) procedures while simultaneously increasing practice expense and malpractice components. This rebalancing results in a substantial potential increase in overall reimbursement, particularly for prostatic urethral lift and water vapor therapy procedures, assuming the proposed rule becomes finalized.

This reimbursement enhancement could significantly expand access to minimally invasive BPH treatments for appropriate patient populations. The improved financial incentives may enable practices to capture more younger men who are typically averse to more invasive therapies that carry substantially higher risks of sexual adverse effects. These patients often have busy lifestyles and prefer to avoid hospital-based procedures with their associated time commitments and recovery periods. The enhanced reimbursement structure supports offering these office-based interventions to men who might otherwise delay or avoid treatment.

The broader clinical implications of this reimbursement change could fundamentally alter BPH treatment paradigms by enabling earlier intervention. Because α-blocker therapy does not appear to prevent progression of bladder deterioration, a nontrivial minority of men are currently missed or inadequately treated in existing algorithms. With improved reimbursement supporting office-based procedures, clinicians can offer more definitive interventions earlier in the disease process. This earlier intervention approach may provide men with a real opportunity to preserve long-term bladder function that would otherwise deteriorate over time. By addressing obstruction before significant bladder damage occurs, these minimally invasive procedures could prevent the progression to more complex clinical scenarios requiring more extensive surgical intervention.