54401
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
10.18
Facility
$617.58
Non-Facility
$617.58
Documentation Required
- No documentation requirements specified in provided text.
- No specific documentation requirements are provided in the provided excerpt
- The document includes sections such as 'Coding Information', 'Coverage Determination', and 'Summary of Evidence' but specific required medical record elements, test results, or clinical notes are not included in the excerpt
- Refer to CMS Medicare Coverage Database for the most current applicable CMS National Coverage Determination (NCD)/Local Coverage Determination (LCD)/Local Coverage Article (LCA).
Key Coverage Criteria
- Nonsurgical treatment for PD may include oral medications
- Nonsurgical treatment for PD may include injections
- Nonsurgical treatment for PD may include traction
- Nonsurgical treatment for PD may include vacuum therapy
- Patients with PD presenting with penile pain.
- Patients with PD presenting with erection deformity (penile deformity).
11 Active Policies
AMBETTER-CP.MP.95 — Gender-Affirming Procedures
HUMANA-ERECTILE-DYSFUNCTION-AND-PEYRONIES-DISEASE-TREATMENTS-MA — Erectile Dysfunction and Peyronie's Disease Treatments - Medicare Advantage
BCBSIL-SUR717.001 — Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
BCBSMT-SUR717.001 — Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
Related Codes
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