Prostatectomy

Applies to:

All plans

Definition

The surgical removal of all or part of the prostate gland.

Medical policy

Patients must meet InterQual criteria for the service to be covered.

Prostatectomy authorizations

Priority Health requires prior authorization for radical prostatectomies.

Participating providers: Use the Auth Request tool to request through GuidingCare

Non-participating providers: Use the Medical Authorization Request form (PDF)

After the service is authorized, pre-service education is recommended for:

• Group and individual HMO, EPO, POS and PPO plan members
• Medicare plan members
• Medicaid and Healthy Michigan Plan members