Male Sexual Dysfunction Treatment: Non-pharmacologic - (0403)

Cigna covers surgical implantation of a penile prosthesis for erectile dysfunction (CPT 54400/54401/54405; HCPCS C1813/C2622) only when ED has persisted ≥6 months and conservative therapies (oral PDE5 inhibitors, intracavernosal/intraurethral meds, and/or vacuum devices) have failed, been contraindicated, or not tolerated, while penile prosthesis for other indications, nerve grafting during/after radical prostatectomy, and application of amniotic-derived allografts to neurovascular bundles are considered not medically necessary (specific non-covered CPT/HCPCS/Q-codes listed). Key requirements are documentation of ≥6 months of ED, a comprehensive history/physical with appropriate labs, documented failure/contraindication/intolerance of conservative management, evidence the service is a covered benefit under the member’s plan, and correct coding or claims will be denied.

"Surgical implantation of a penile prosthesis is considered medically necessary for the treatment of erectile dysfunction when ALL of the following criteria are met:"