Insurance & Medicare for HIFU and TULSA-PRO
Understand what may be covered and what would be out of pocket for treatment with Dr. Stephen Scionti.
HIFU: Insurance & Medicare
For the HIFU procedure there are two separate fees: what you pay to Scionti Prostate Center for Dr. Scionti's professional fees, and what is paid to the facility for the hospital and anesthesia fees. Dr. Scionti performs HIFU at Lakewood Ranch Medical Center.
Patients with Traditional Medicare (Part B)
Scionti Prostate Center welcomes patients with Medicare. Dr. Scionti has opted out of the Medicare program, and payment for his professional services is by private arrangement and is not covered by Medicare.
Hospital and anesthesia services associated with HIFU treatment are covered for patients with Traditional Medicare (Part B) with no authorization needed. Deductibles, copayments or coinsurance may apply. Any supplemental coverage should also be reviewed.
Medicare Advantage and private insurance
If you have Medicare Advantage or commercial insurance, there may be coverage for the facility and anesthesia fees, depending on your specific policy.
Once Dr. Scionti has reviewed your medical records and qualified you as a candidate for HIFU, our office can connect you with our specialty team to discuss your insurance benefits and coverage. If required and permitted under your specific insurance policy, we will assist with obtaining prior authorization for the procedure.
Please note that obtaining authorization does not guarantee payment or coverage. Hospital and anesthesia fees are separate and are the responsibility of the patient to coordinate directly with the hospital or facility. Ultimately, your insurance company determines whether the HIFU procedure is covered under your individual policy and what portion, if any, will be covered.
Personalized treatment and ongoing care
Out of pocket costs are one factor in making a treatment decision. Dr. Scionti personally performs HIFU and develops a treatment plan using your MRI findings and cancer characteristics. His approach includes MRI-based treatment planning and advanced techniques to optimize energy delivery to the targeted tissue.
Your HIFU fee includes follow-up care for 90 days post treatment. Annual follow-up visits in person or via TeleHealth are encouraged. There are professional fees for any appointments beyond the 90 days, and our team is happy to review this with patients prior to scheduling.
Find out whether HIFU is an option for you
Contact Scionti Prostate Center to begin a case review and discuss insurance coverage. Have your insurance information, biopsy report, PSA history and prostate MRI information available. Our team can explain how to submit records and next steps.
Call 866-866-8967 or request a HIFU case review.
Coverage and costs depend on your benefits, clinical circumstances and the services provided. Confirm your written estimate and coverage details before scheduling treatment.
TULSA-PRO: Insurance & Medicare
The TULSA-PRO procedure involves two separate fees: the professional fee paid to Scionti Prostate Center for Dr. Scionti's services, and the facility and anesthesia fees, paid directly to the hospital. Many of the other TULSA providers can only provide an estimate of fees. Scionti Prostate Center can provide an accurate, flat rate fee for the entire procedure when there is no reimbursement by your insurance carrier.
Patients with Traditional Medicare (Part B)
Dr. Scionti has opted out of the Medicare program, and payment for his professional services is by private arrangement and is not covered by Medicare. Our office will review with you the professional fees for the TULSA-PRO procedure.
Our TULSA program provides treatment at BayCare Hospital Wesley Chapel. The hospital setting allows patients with Traditional Medicare (Part B) to have coverage for the hospital and anesthesia fees with no authorization needed. Deductibles, copayments or coinsurance may apply. Any supplemental coverage should also be reviewed.
Medicare Advantage and commercial insurance
In our experience, coverage of the TULSA procedure by Medicare Advantage and commercial insurance is uncertain and unreliable. Currently, patients need written authorization with dates from their Medicare Advantage plan or commercial insurance for the hospital to consider accepting a claim for the hospital and anesthesia fees. Once Dr. Scionti has reviewed your medical records and qualified you as a candidate for TULSA-PRO, our office can connect you with a specialty team that will review your insurance benefits and coverage. They will help with obtaining written authorization for the procedure.
Please note that obtaining authorization does not guarantee payment or coverage. Hospital and anesthesia fees are separate and are the responsibility of the patient to coordinate directly with the hospital. Ultimately, your insurance company determines whether the TULSA-PRO procedure is covered under your individual policy and what portion, if any, will be covered.
Get a clear picture of your TULSA costs without insurance coverage
If your Medicare Advantage plan or commercial insurance denies authorization for the TULSA-PRO, or if you are a self-pay patient with no insurance, we can provide you with the exact cost of the procedure. Our office is one of the few that perform this procedure in a hospital-based setting with a set flat fee rate. You will not have to worry about hidden fees or costs; we will review everything with you prior to scheduling.
Experience and a plan tailored to your diagnosis
Dr. Scionti was among the first physicians in the United States to perform the TULSA procedure, completing his first case in 2020, building on his experience in prostate ablation. He uses MRI information to plan treatment around the location and characteristics of the tissue being treated. The TULSA system uses MRI guidance and temperature monitoring during the procedure.
Choosing care also means understanding what happens afterward. Our team develops a follow-up plan for continued prostate cancer monitoring. During your review, discuss the expected benefits, possible complications, alternatives and whether TULSA fits your individual diagnosis. No treatment can guarantee cancer control or preservation of urinary or sexual function.
Start with a TULSA case review
Contact Scionti Prostate Center with your insurance information, biopsy report, PSA history and prostate MRI information. We can explain the records needed to assess candidacy and the next steps for reviewing coverage and costs.
Call 866-866-8967 or request a TULSA case review.
Hospital coverage does not include Dr. Scionti's privately paid professional fees. Benefits and costs vary; confirm your written estimate and coverage details before scheduling treatment.
Medicare-approved HIFU CPT code, 55880 and TULSA CPT code, 55882, will allow hospital outpatient facility reimbursement for hospital costs.
HIFU has been assigned CPT Code 55880: Ablation of prostate, transrectal, high intensity focused ultrasound (HIFU), including imaging guidance. CPT Code 55880 became effective Jan 1, 2021.
TULSA CPT Code 55882 - Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducers for delivery of the thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed by a single physician.
A billing code is only part of the answer
An insurer saying that a procedure code is "valid and billable," or that "no authorization is required," does not by itself establish that your treatment will be paid for. Ask for a patient-specific coverage determination when available and clarification of your financial responsibility. Prior authorization, when required, is an important step, but is not an unconditional guarantee of payment.
Coverage at a glance
- Traditional Medicare (Part B): hospital and anesthesia fees are covered with no authorization needed, for HIFU at Lakewood Ranch Medical Center and TULSA-PRO at BayCare Hospital Wesley Chapel. Deductibles, copayments or coinsurance may apply.
- Dr. Scionti's professional fee: Dr. Scionti has opted out of the Medicare program. Payment for his professional services is by private arrangement and is not covered by Medicare.
- Medicare Advantage and commercial insurance: coverage of hospital and anesthesia fees depends on your policy. Once you are qualified as a candidate, our specialty team will review your benefits and help with authorization.
- Authorization is not a guarantee: your insurance company determines whether the procedure is covered and what portion, if any, will be covered.
Request a case review
Call 866-866-8967 or use the button below to request a HIFU or TULSA-PRO case review.
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