L7900 — Male vacuum erection system
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted.
- For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have received a signed WOPD before delivering the item to the beneficiary.
- When separately billing associated options, accessories, and/or supplies, the WOPD for the base item must list the base item and may list the separately billed accessories prior to delivery.
- Suppliers are required to maintain proof of delivery (POD) documentation in their files and make it available to the Medicare contractor upon request.
Key Coverage Criteria
- Item must be eligible for a defined Medicare benefit category to be covered.
- Item must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- Item must meet all other applicable Medicare statutory and regulatory requirements and applicable payment rules (including LCD-related Standard Documentation Requirements and LCD-related Policy Article) prior to reimbursement.
- Durable medical equipment, orthotics, and prosthetics that are necessary and reasonable for the treatment of an illness or injury or to improve the functioning of a physical deficit.
- Equipment expected to make a meaningful contribution to treatment of the patient’s illness or injury or to improvement of a malformed body member.
- Coverage only when education regarding use of the device has been provided with demonstrated understanding and a trial of the requested device has been completed with demonstrated ability to use it safely and effectively.
7 Active Policies
L34824 — Vacuum Erection Devices (VED)
J19
BCBSIL-MED201.030 — Sexual Dysfunctions, Assessment and Treatment
AMBETTER-CP.MP.107 — Durable Medical Equipment and Orthotics and Prosthetics Guidelines
BCBSNM-MED201.030 — Sexual Dysfunctions, Assessment and Treatment
BCBSOK-MED201.030 — Sexual Dysfunctions, Assessment and Treatment
Related Codes
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