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.

Protatectomy authorizations

Priority Health requires prior authorization for radical prostatectomies.

Participating providers: Use the Auth Request tool to request through Clear Coverage™

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

Pre-service education and shared decision-making

Shared decision-making is a collaborative process where the provider helps the patient understand their treatment options, risks and benefits, and then helps them apply their values and preferences in order to make a decision.

Using Emmi® to facilitate shared decision-making

Emmi® programs take complex information and make it easy for a patient and family to understand treatment options and what they can do before, during and after surgery to improve outcomes. You can provide patients with this Prostate Cancer Pre-Service Education sheet at any time.

Once your prior authorization request is approved, Priority Health will send our member an Emmi® video electronically, with a recommendation to view one of these shared decision-making videos within 48 hours of receiving it.

The video they receive depends on their risk. The video, "Prostate Cancer: Low Risk Treatment Options," or "Prostate Cancer: Intermediate and High Risk, Localized Treatment Options," can be viewed online, via computer, smart phone or tablet.

Order Emmi programs

You can order the appropriate program on the Emmi® website.

  1. Enter your patient's information and email address
  2. Click the View Program button
  3. The program will be automatically emailed to your patient for them to complete.

    Note: The program will start automatically and you can just close the browser at this time.

Additional Emmi resources available

Physicians may order these additional programs for our Priority Health patients:

  • Benign Prostatic Hyperplasia (BPH) Treatment Options
  • Radical Prostatectomy
  • Radical Prostatectomy: Robot-Assisted
  • Transurethral Resection or Ablation of the Prostate
  • Advance Directives
  • Palliative Care