Prostate Cancer Treatment Insurance Coverage


The Foundation has recently learned that a small number of patients have had focused ultrasound (FUS) treatment for their service-related prostate cancer covered by the US Department of Veterans Affairs (VA). This isn’t a department-wide decision or even a Veterans Integrated Services Networks (VISN) wide decision. Rather, success has been patient driven and has occurred at the individual facility level.

doctor consult1Please be aware that the Foundation does not ensure reimbursement or coverage of focused ultrasound treatment in any way and has outlined the following steps based on input from the VA and patients’ personal accounts.

To apply for VA coverage of focused ultrasound treatment for service-related prostate cancer, please consider the following path:

  1. The patient must have a physician in the VA who will request a “Care in the Community” consultation. The patient will need to know the name of the FUS physician he wishes to have perform treatment.
  2. The VA physician will complete and submit the “Care in the Community” consultation, and VA administration will contact the FUS physician’s office, arrange an agreement for the patient, and inform the patient that he may see that FUS physician. 
  3. The patient sees the FUS physician and receives the care.
  4. The VA pays the FUS physician upon submission of a HCFA 1500 to the VA for payment.

There are several factors that may impact this process. The fact that a coverage decision happens at the lowest level of organization at the VA and on a case-by-case basis is likely to result in some variability in response from location to location. The patient’s eligibility is also a consideration, as the rated service-connected disability and other considerations may impact the veteran’s qualification to receive this treatment.

The use of Agent Orange, a Vietnam era herbicide and defoliant, is associated with development of prostate cancer and other diseases. Therefore, prostate cancer is a prevalent problem in the aging veteran community. According to the VA website, “Veterans with prostate cancer who were exposed to herbicides during service may be eligible for disability compensation and health care.”

In 2015, two focused ultrasound devices – SonaCare Medical’s Sonablate 450 and EDAP TMS’s Ablatherm Robotic HIFUearned FDA approval for the ablation of prostate tissue. This month, a third device (and the second from French company EDAP), Focal One, earned the same FDA approval. This designation from the FDA to “ablate prostate tissue” allows physicians to treat conditions like benign prostatic hyperplasia (BPH) and prostate cancer using these devices.

For the latest information on availability and treatment sites, we recommend contacting the manufacturers – EDAP TMS and SonaCare Medical. Also note there are additional sites that use mobile focused ultrasound equipment. These sites may not be listed on the EDAP or SonaCare sites, and the best way to find them is to contact local urologists to see if they have focused ultrasound capability.

The Foundation is seeking more information about prostate cancer treatment being granted insurance coverage. As part of our partnership with the Medical Imaging & Technology Alliance (MITA), we are working to determine the VA’s current coverage policy for focused ultrasound. We will provide updates in future issues of the newsletter as they become available.