Coding Information
The Vanquish System is a minimally invasive procedure designed to ablate targeted prostate tissue. Performed under ultrasound guidance, the procedure deploys thermal water in the form of vapor (steam) transurethrally to ablate targeted tissue in any zone of the prostate.
Francis Medical encourages providers to submit claims for the Vanquish System procedure that are accurate based on the provider’s assessment of the patient’s condition. It is the provider’s responsibility to code to the highest level of specificity when reporting a patient’s condition and services rendered, and to verify appropriate coding for reporting procedures using the Vanquish System.
Diagnosis Coding
The following ICD-10 Diagnosis Code may be associated with the Vanquish procedure. It is the provider’s responsibility to report diagnosis code(s) that accurately describe the patient’s condition.
| C61 | Malignant neoplasm of prostate |
Physician Coding & Medicare Payment
Information
The following CPT code is associated with the Vanquish procedure. It is the provider’s responsibility to report procedure code(s) to the highest level of specificity that accurately describe the services performed.
Because Category III CPT codes do not have established relative value units (RVUs), including physician work and practice expense values, a comparison Category I CPT code representative of similar time, work, effort/skill, and complexity involved with performing the Vanquish procedure, can serve as a helpful proxy to your health plans to educate them on the Vanquish procedure and to support your requested charges. Medicare and commercial health plans will determine physician payment for these services on a case-by-case basis, likely following a review of documentation when requested. Contact your local Medicare contractor and/or commercial health plans for more information on their process.
Medicare Advantage plans and non-Medicare payers (including commercial health plans) have proprietary fee schedules that are not publicly available. Verify payment rates, coding, and claims reporting requirements with your contracted health plans.
| CPT® CODE | DESCRIPTION | OFFICE MEDICARE NATIONAL UNADJUSTED ALLOWED AMOUNT | FACILITY MEDICARE NATIONAL UNADJUSTED ALLOWED AMOUNT |
| 0582T | Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imaging and needle guidance | Carrier Priced | Carrier Priced |
Facility Coding & Medicare Payment
Information
The following are 2026 national unadjusted Medicare payment rates for Hospital Outpatient Departments and Ambulatory Surgery Centers (ASCs) associated with the Vanquish procedure CPT code. These rates apply to services furnished to Medicare Fee-for-Service beneficiaries and may be subject to geographic and other adjustments. Please consult www.cms.hhs.gov or contact your local Medicare contractor for more information.
Medicare Advantage plans and non-Medicare payers (including traditional commercial health plans) have proprietary facility fee schedules that are not publicly available. Verify payment rates, coding, and claims reporting requirements with your contracted health plans.
| CPT® CODE | DESCRIPTION | MEDICARE APC | APC ALLOWED AMOUNT | SI | ALLOWED AMOUNT | SI |
| 0582T | Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imaging and needle guidance | 5377 | $13,479.22 | J1 | $10,892.79 | J8 |
| HCPCS DESCRIPTION | |
| C1889 | Implantable/insertable, device not otherwise classified |
Additional Medicare payment is not allowed for C1889, however including a separate device code will ensure claims are processed accurately and timely. Assigning C1889 to the corresponding revenue center with appropriate charges for the device based on your hospital’s unique CCR, will help to ensure future APC assignment and rate setting. Commercial insurers may process C1889 separately for payment.
Prior Authorization
Medicare
Traditional Medicare Fee-for-Service (Medicare Parts A and B) does not currently require prior authorization.
Medicare Advantage & Non-Medicare Health Plans
Medicare Advantage plans and non-Medicare health plans (including commercial health plans) typically require prior authorization. Contact the patient’s health insurance plan to understand their prior authorization and medical necessity requirements before initiating treatment. Francis Medical has created supporting documents, including example template letters, for illustrative purposes only, to support your efforts. The example template documents are available in our supporting documents section. Providers are solely responsible for preparing and submitting prior authorization and/or appeal documentation.
Denials & Appeals
Whether you receive a prior authorization denial, claim denial, or insufficient payment, you have the right to appeal. The appeal process ensures that critical patient treatment decisions are given appropriate consideration. When submitting an appeal, please refer to and follow the health plan’s defined appeal process.
Prior Authorization Denials
Prior authorization denials may be the result of:
- Missing or incomplete medical record documentation
- The health plan does not yet fully understand the procedure
You always have the right to appeal a denied prior authorization request. Francis Medical has created, for illustrative purposes only, an example template appeal letter, which is available upon request. Consider submission of additional information to the health plan as part of the appeal process, including medical records and other supporting clinical documents (e.g., Biopsy results, imaging, etc.). Always submit your appeal in accordance with the health plan’s process and timeline. Providers are solely responsible for preparing and submitting appeal documentation within the health plan’s timeline.
Additionally, patients through their provider can participate in a Francis Medical sponsored Patient Access Program through JDL Access, a third party. On behalf of the patient, and with the patient’s authorization, JDL Access can provide support with the prior authorization process, including appeals, as necessary. Prior authorization and predetermination are not a guarantee of payment. Click here to learn more about the Vanquish System Patient Access Program.
Support Documents
- Vanquish procedure Reimbursement Resources
- Example Template Prior Authorization Letter (Available upon request)
- Example Template Appeal Letter-Medical Necessity (Available upon request)
- Example Template Appeal Letter-Experimental Investigational (Available upon request)
- Example Common Urology Procedures 2025 Allowed Amounts Sheet (Available upon request)
- Example Common Urology Procedures 2025 Allowed Amounts – Hospital Employed Physicians Sheet (Available upon request)
- Example Template Comparison Procedure Cover Letter (Available upon request)
- Example Template Operative Report [add hyperlink to Word document]
- Medicare Part B Best Practices – Submitting Documentation with Initial Claim Form
- Coding References
- Clinical Bibliography
- Bibliography
- FDA Clearance
Vanquish Procedure Reimbursement FAQ’s
The Vanquish procedure is a minimally invasive procedure designed to ablate targeted prostate tissue. Performed under ultrasound guidance, the procedure deploys thermal water in the form of vapor (steam), transurethrally, to ablate targeted tissue in any zone of the prostate.
The following ICD-10 Diagnosis Code (Dx) may be associated with the Vanquish procedure. It is the provider’s responsibility to report diagnosis code(s) that most accurately describes the patient’s condition(s). Diagnosis codes in addition to a primary Dx code may also be reported. Verify accurate Dx coding requirements with the health plans.
| ICD-10 | DESCRIPTOR |
|---|---|
| C61 | Malignant neoplasm of prostate |
The following CPT code is associated with the Vanquish procedure. It is the provider’s responsibility to code to the highest level of specificity to report a patient’s condition for services rendered. Francis Medical encourages providers to verify appropriate coding and submit claims for the Vanquish procedure that are accurate based on the provider’s assessment of the patient’s condition.
| 2026 CPT/HCPCS CODES | 2026 DESCRIPTOR |
|---|---|
| 0582T | Transurethral ablation of malignant prostate tissue by high-energy water vapor thermotherapy, including intraoperative imagining and needle-guidance |
| FACILITY CODING: HOSPITAL OUTPATIENT OR AMBULATORY SURGERY CENTER (ASC) | ||||||
|---|---|---|---|---|---|---|
| HOSPITAL | ASC | |||||
| CPT® Code | Medicare APC | APC Description | APC Allowed Amount | SI | Allowed Amount | SI |
| 0582T | 5377 | Level 7 Urology and Related Services | $13,479.22 | J1 | $10,892.79 | J8 |
| DEVICE CODE – HOSPITAL OUTPATIENT ONLY | |
|---|---|
| HCPCS Code | Description |
| C1889 | Implantable/insertable, device not otherwise classified |
Additional Medicare payment is not allowed for C1889, however including a separate device code can ensure claims are processed accurately and timely. Assigning C1889 to the corresponding hospital revenue center with appropriate charges for the device based on your unique CCR, will also help to ensure future APC assignment and rate setting remain appropriate for the Vanquish procedure. Commercial insurers may process C1889 separately for payment. Please verify with your commercial insurers.
National relative value units (RVUs) are not established for Category III CPT codes. Because Category III CPT codes do not have established physician work and practice expense values, referencing an existing Category I CPT code(s) as a comparison can serve as a helpful proxy to describe the work, time, and complexity associated with performing the Vanquish procedure. Medicare and commercial health plans will determine physician payment for these services on a case-by-case basis following review of documentation, as requested.
Category III codes are common so many health plans, including Medicare, may allow submission of a cover letter in which you can identify a comparable procedure code and describe why you believe there are similarities in work, time, and complexity between the Vanquish procedure and the identified comparison procedure. You can also describe differences between the two procedures including whether the Vanquish procedure requires more or less work, time, and complexity than the identified procedure (see question below). It can be helpful to provide in your cover letter the associated RVUs for the identified comparison procedure, and your intended charges for the Vanquish procedure. Contact the health plan for specific billing instructions.
A best practice when reporting a service using a new Category III CPT code can be to use the freeform field (box 19) of the claim form to list the identified comparison CPT code, including its 2026, geographically adjusted Medicare RVUs and allowed amount. This may be useful in helping the health plan to understand how you came up with your charge for the Vanquish procedure. For example, “0582T (Vanquish procedure Category III CPT code) comparable to XXXXX (identified comparator CPT code), requested payment amount $XXX. XX.” It is important to remember health plans will make their own payment determinations for Category III CPT codes. Contact the health plan for specific billing instructions.
When submitting a claim using a Category III CPT Code, including for the Vanquish procedure, Medicare may request providers submit additional documentation through the Medicare Paperwork (PWK) process to be able to accurately adjudicate the claim. The PWK process will allow you to alert Medicare when submitting an electronic Part B claim that you’re also intending to submit supporting documentation separately via mail or fax. Refer to your local MAC website for detailed instructions on your MAC’s PWK process
The following documentation is an example of documentation that may be requested through the PWK process at the time of the initial claim submission:
- History and physical notes.
- Lab/Biopsy/Diagnostic test results, if applicable.
- Progress/office notes specific to the patient’s condition.
- Operative/procedure report for the Vanquish
procedure.
- Relevant peer reviewed articles
- Society guidelines, if available
- Any additional documentation that supports the need for the Vanquish procedure.
The Category III service billed may be rejected or denied by Medicare if the PWK process is not followed, necessitating resubmission of the claim and or appeal
Francis Medical has created example materials, including sample letters, for illustrative purposes only. Sample materials are available on request from the Francis Medical Reimbursement team. Providers are solely responsible for preparing and submitting prior authorization requests and/or appeals through the health plans process and ensuring that the information included accurately reflects the patient’s condition.
Additionally, patients through their provider can participate in a Francis Medical sponsored Patient Access Program through a third party, JDL Access. On behalf of the patient, and with the patient’s authorization, JDLA can provide support with the prior authorization process, including appeals, as necessary. Prior authorization and or predetermination are not guarantees of payment.
You may contact your health plan to confirm coverage and their medical necessity requirements. Medical Policies, Coverage
Determination Guidelines, and Utilization Review Guidelines are developed by individual health plans for services and
procedures, as needed, and are subject to change. Regardless of level of CPT coding, in the absence of written medical
policy, medical necessity determinations for coverage are made on a case-by-case basis.
To increase the likelihood of achieving payment, Francis Medical recommends not proceeding with commercial insurance cases, including Medicare Advantage, unless prior authorization or predetermination is obtained in writing.
Vanquish procedure. In the absence of an NCD or LCD, individual Medicare
Administrative Contractors (MACs) will determine if an item or service is “reasonable and necessary” on a claim-by-claim
basis pursuant to Section 1862(a)(1)(A) of the Social Security Act.³
Vanquish Reimbursement Support
Francis Medical is dedicated to answering questions and providing support to healthcare providers that are bringing the power of water vapor to their prostate cancer patients. Please let us know how we can help.
Federal law (USA) restricts this device to sale by or on the order of a physician.
Refer to the device User Manual for a list of contraindications, warnings, and cautions.
Training: Do not operate the Vanquish System without completing Francis Medical-provided physician training. Untrained operation of the device may lead to improper use. Improper use can result in patient injury or equipment malfunction.