Does Medicare Cover UroLift? Coverage, Cost & Coding Explained

Is UroLift covered by Medicare?

Yes. UroLift, also called the prostatic urethral lift, is an outpatient surgical procedure used to relieve the symptoms of an enlarged prostate (benign prostatic hyperplasia, or BPH). Tiny implants lift and hold the prostate tissue out of the way so urine can flow more freely. Medicare treats it like other covered surgeries.

There is no National Coverage Determination (NCD) for the prostatic urethral lift. In plain terms, there is no single nationwide Medicare rule that spells out the exact criteria for this one procedure. Instead, the regional company that processes Medicare claims in your area (a Medicare Administrative Contractor, or MAC) decides coverage based on whether the procedure is medically necessary for you. An earlier local coverage policy and billing article were retired, so this is now handled through local/medical-necessity review.

What this means for you: as long as your urologist documents that UroLift is medically necessary for your BPH, Original Medicare generally covers it. If you have a Medicare Advantage plan, coverage follows the plan's own rules (more on that below).

Is UroLift covered under Part A or Part B?

UroLift is almost always covered under Medicare Part B, because it is performed as outpatient surgery in a hospital outpatient department or an ambulatory surgical center. Part B is the part of Original Medicare that pays for doctor services and outpatient procedures.

Part A (hospital insurance) would only come into play in the rare case that you were formally admitted to the hospital as an inpatient and the procedure happened during that stay. If that happened, Part A cost-sharing would apply instead, including the 2026 inpatient deductible of $1,736 per benefit period. For the vast majority of patients, UroLift is an outpatient Part B procedure and Part A is not involved.

To keep your Part B coverage active, you must continue paying the Part B premium. The standard Part B premium in 2026 is $202.90 per month.

How much does UroLift cost with Medicare in 2026?

Under Original Medicare (Part B), your share works like most outpatient surgeries:

• First, you meet the annual Part B deductible: $283 in 2026. You pay this once per year before Medicare starts paying its share.
• After the deductible, Medicare pays 80% of the Medicare-approved amount and you pay the 20% Part B coinsurance.
• There is no cap on the 20% coinsurance under Original Medicare by itself, which is one reason many people add a Medigap policy.
• Where you have the procedure can change your cost. An ambulatory surgical center (ASC) often costs less than a hospital outpatient department (HOPD).

ASC vs. hospital: compare your price and check the codes

Because an ambulatory surgical center can cost less than a hospital outpatient department, it is worth comparing before you schedule. You can look up the Medicare price for the procedure in both settings using Medicare's official Procedure Price Lookup tool at medicare.gov/procedure-price-lookup. Search the procedure code (CPT 52441) to see the typical Medicare-approved amount and your estimated 20% share in each setting.

Understanding the billing codes can help you read your estimate and explanation of benefits. The physician's work for UroLift is reported with CPT code 52441 for the first implant placed, plus add-on CPT code 52442 for each additional implant. When the procedure is done in an ASC or hospital outpatient department, the facility itself reports HCPCS code C9739 (for 1 to 3 implants) or C9740 (for 4 or more implants).

• CPT 52441 - placement of the first/initial implant (physician)
• CPT 52442 - each additional implant, add-on code (physician)
• C9739 - facility code for 1-3 implants (ASC/HOPD)
• C9740 - facility code for 4 or more implants (ASC/HOPD)

Medicare Advantage, prior authorization, and medical necessity

Original Medicare does not require prior authorization for the UroLift / prostatic urethral lift procedure. Your urologist documents medical necessity and bills Medicare directly.

Medicare Advantage plans are different. A Medicare Advantage plan may require prior authorization before it will approve UroLift, and it will use its own provider network and rules. If you have a Medicare Advantage plan, ask your plan whether prior authorization is needed and confirm that your urologist and surgical facility are in network. Your costs and approval steps are set by the plan, so check your plan's documents or call the number on your card.

Either way, coverage hinges on medical necessity. That generally means you have BPH symptoms that warrant treatment and your physician documents why UroLift is appropriate. This is the same standard Medicare uses for the more traditional BPH surgery, TURP (transurethral resection of the prostate). Both procedures can be covered when medically necessary; the right choice for you is a clinical decision to make with your urologist, not a coverage decision.

How Medigap reduces what you pay

Because Original Medicare leaves you responsible for the 20% Part B coinsurance with no annual limit, many people buy a Medicare Supplement (Medigap) policy to fill that gap. Most Medigap plans cover the Part B coinsurance in full, which means a Medigap policy can pay the entire 20% coinsurance for your UroLift procedure.

Medigap works only alongside Original Medicare, not with a Medicare Advantage plan. Benefits are standardized by plan letter, so what each lettered plan covers is the same from one insurer to the next, though premiums differ. To see how the plans compare, visit medicare.gov/health-drug-plans/medigap.