Do Blue Cross Insurance Plans Cover Penile Implant surgery?
Penile Prosthesis Coverage By Blue Cross Plans
There are many different Blue Cross plans and each plan is a little different.
In general, most Blue Cross commercial PPO and HMO plans including Anthem Blue Cross, Empire BCBS, Horizon BCBS, CareFirst Blue Cross, Highmark BC, Blue Cross of Texas, BC of California, Blue Cross of Illinois, BC of Florida and other Blue Cross plans have coverage for penile implantation surgery for men with organic erectile dysfunction.
All Medicare Advantage plans issued by Blue Cross plans are mandated by law to cover penile implant surgery. Medicare Advantage plans are required to offer all the coverage benefits offered by traditional Medicare, which covers penile implants.
Blue Cross plans purchased from state and federal exchanges usually cover the cost of penile implant surgery. Most but not all employer-sponsored health plans cover the cost of penile implant surgery.
In general, pre-authorization and documentation of erectile dysfunction are necessary for the insurance company to approve penile prosthesis surgery. Typically, this involves sending urologist’s notes about prior treatment and diagnostic evaluation including diagnosis (ICD10 codes). At New York Urology Specialists we take care of all preauthorizations for our patients.
Typically, penile implant surgery is covered by Blue Cross plans for patients who do not respond to oral therapy with medications such as Viagra, Cialis, Levitra or Stendra or who have a contraindication to these medications.
While many plans do not cover medications for ED such as Viagra (sildenafil), Cialis, Levitra, and Stendra, most plans cover the costs of penile prosthesis surgery. Benefits vary from plan to plan and need to be verified.
Other health plans such as Cigna, Aetna, Oxford, and United Healthcare often cover the costs of a penile prosthesis.
Typical criteria for coverage of penile implant by Blue Cross insurance plans include the following:
Neurogenic impotence of greater than one-year duration due to one of the following:
- Spinal cord injury/disease;
- Multiple Sclerosis;
- Spina Bifida;
- Radical prostatectomy;
- Rectal surgery;
- Fractured pelvis.
Vasculogenic (vascular) impotence of greater than one-year duration due to one of the following:
- Intrapenile arterial disease;
- Status post cavernosal infection;
- Peyronie’s disease;
- Penile contusion;
- Penile fracture;
Patients with other causes of erectile dysfunction may also qualify for penile implant surgery.
If you want to verify benefits, you can call your insurance company
The phone number is located on the back of your insurance card and provide them with the following codes:
Commonly used ICD10 Diagnostic Codes:
- N52.01 Erectile dysfunction due to arterial insufficiency
Commonly Used CPT Procedure codes:
- 54400 Insertion of a penile prosthesis; non-inflatable (semi-rigid)
- 54401 Insertion of a penile prosthesis; inflatable (self-contained)
- 54405 Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir
- 54410 Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session
- 54411 Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue
- 54416 Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session
- 54417 Removal and replacement of a non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue
- C1813 Prosthesis, penile, inflatable
- C2622 Prosthesis, penile, non-inflatable
- L8699 Prosthetic implant, not otherwise specified
- 0VUS0JZ Supplement penis with synthetic substitute, open approach
- 0VUS4JZ Supplement penis with synthetic substitute, percutaneous endoscopic approach
Scheduling Appointments for ED Treatment at New York Urology Specialists
We have excellent reviews from patients and their partners.
We offer affordable, highest-quality urology care with or without insurance. Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.
ED is Treatable in Nearly Every Man
At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction. We understand the challenges that ED creates for our patients, their relationships and their self-esteem. We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.
Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED. We offer medical and surgical treatment for erectile dysfunction.
We Treat Some of the Most Complex ED Problems Including:
- Erectile dysfunction in men with prostate cancer after radical prostatectomy
- Impotence in men with diabetes.
- Erectile dysfunction in men with Peyronie’s disease
- Erectile dysfunction in men for whom Viagra and Cialis do not work.
- Erection problems in men with low testosterone.
Schedule an Appointment with Dr. Shteynshlyuger:
Dr. Alex Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in evaluation and treatment of sexual and erection problems in men using modern effective and proven treatment methods. We offer inflatable penile implant, shockwave therapy for ED and treatment for Peyronie’s disease.
He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.