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.
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).
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.
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 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.
Dr. Alex Shteynshlyuger is a board-certified urologist, who specializes in all aspects of care for sexual problems in men including ED, premature ejaculation and other sexual concerns. He has successfully treated hundreds of men with sexual problems including ED and poor libido.
by Winston on Sep 15, 2018
I am very please and satisfied with everything that has been offorded to me by New York Urology Specialist Office.....Dr Alex
by Wyts on Sep 15, 2018
Wyts Wyts recommends New York Urology Specialists via Facebook. September 15, 2018 · Friendly , courteous, effiecient and professional staff members. This office i highly recommend for any and all Urology matters. Dr Alex Shteynshlyuger is very professional and knowledgable easy to communicate with. Thanks Dr Alex
by Lee St. James on Sep 01, 2018
Dr Alex and his staff are through professionals in every sense of the word. From initial diagnosis to a period of evaluating and ruling out options, we decided upon a surgical solution, which appears for the most part to have corrected the issue. Thanks to Ana, and the staff, especially Dr. Alex for treating me so well. Best regards, Lee
by Christopher cato on Aug 16, 2018
by Andrei on Aug 15, 2018
Dr. Alex Shteynshlyugerand is careful, patient, experienced. Uses innovative approaches, that actually yield results. He is indeed a good doctor, in every sense
by juanito creque on Apr 11, 2018
I am very satisfied with the treatment I received at new york urology specialist and would recommend them to other patients.they are the very best.
by JD on Jan 15, 2018
Well I put it to use last night and man, good job. My wife was elated. u made it much better somehow, so thank u for fixing my penis
by Jacob on Dec 05, 2017
"Cannot express how thankful I am I found Dr. Shtetnshlyuger. After undergoing surgery to correct a penile torsion I couldn't be happier with the results. A great doctor who is clearly good at what he does. With something as important as your private area, It's nice to be able to rest easy and know you are in good hands.." via HealthGrades.com 12/5/2017
by Bob Brown on Nov 19, 2017
I am writing to thank dr. Alex. He is thorough, professional, knowledgeable, helpful and friendly. I have seen him for ED and prostate issues, and he has explained all my options clearly, and found solutions that have been a great help. thank you! I highly recommend both Dr. Alex and his staff, which I find to be helpful, friendly, knowledgeable and very professional. They are a pleasure to deal with and all have been a great help.
by Clarence Brown on Sep 14, 2017
I am very much thankful for meeting Dr Alex .I had a very serious medical problem I visited many doctors but none could not help me it was very difficult for me until I visited Dr Alex after a couple visits my medical problem is no more I feel very great also I felt almost 20 years younger Dr Alex is second to none fantastic doctor. Thanks again Dr Alex from my family.
by Michael on Jul 03, 2014
I am feeling better now after visiting clinic New York urology specialists. Excellent staff and appointment on time.
by George & Sally R on Jan 07, 2013
Dear Dr. Alex: We want to thank you for the excellent care you provided for George during his emergency operation and the follow up treatment. Your quiet, confident manner was reassuring to us during a very scary time for us. We will never forget you. George Sally R. Date: 2013
by Joyce T on Feb 16, 2012
Dr. Alex Shteynshlyuger and Staff – Thank you so much for taking care of my husband Bob. Dr. Alex: I thank God everyday for you. You were an answer to prayer.
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
- ED in men with multiple sclerosis
- impotence in men with diabetes.
- Priapism in men and other emergency penis problems.
- 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 urological problems in men and women 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.
We see patients from all parts of New York City (Manhattan, Brooklyn, Queens, Bronx, Staten Island), Long Island, Westchester, and New Jersey as well as other parts in the USA, Canada, South America and the Caribbean and other international patients. We also offer emergency care for men with urological problems.
If you experience ED, it is important not to ignore the problem and to get a prompt evaluation for ED from your doctor. If you don’t see your doctor, these problems will go undetected and untreated.