CMS Cryosurgery of Prostate Form

Cryosurgery of the prostate gland, also known as cryosurgical ablation of the prostate (CSAP), destroys prostate tissue by applying extremely cold temperatures in order to reduce the size of the prostate gland. It is safe and effective, as well as medically necessary and appropriate, as primary treatment for patients with clinically localized prostate cancer, Stages T1-T3.

Cryosurgery of the prostate as a salvage therapy is not covered for any services performed prior to June 30, 2001.

Salvage Cryosurgery of Prostate After Radiation Failure. Salvage cryosurgery of the prostate for recurrent cancer is medically necessary and appropriate only for those patients with localized disease who:

1. Have failed a trial of radiation therapy as their primary treatment; and
2. Meet one of the following conditions: Stage T2B or below, Gleason score <9, PSA <8 ng/mL.

Cryosurgery as salvage therapy is therefore not covered under Medicare after failure of other therapies as the primary treatment. Cryosurgery as salvage is only covered after the failure of a trial of radiation therapy, under the conditions noted above.