Treatment of sexual dysfunction is eligible for payment only when the condition is the result of or related to an organic disease or injury. In these instances, covered services include, but are not limited to:

• Nocturnal penile tumescence recordings (54250)
• Insertion and removal of penile prosthesis (54400-54417)
  

Follow-up surgery to the insertion of a prosthesis because of infection and/or malfunction of the device should be paid under the appropriate procedure code.

Venous ligation is performed as treatment for patients with failure to store blood in the cavernosa. Venous ligation is not an eligible service on the basis of medical necessity.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Services and supplies (including drugs and devices) related to the treatment of sexual dysfunction or inadequacies are not covered regardless of whether the cause of the impotency is organic or psychological/psychiatric. However, services such as the initial diagnostic testing that may be required to determine if the sexual dysfunction or inadequacy is due to an organic or pathological problem (e.g., nocturnal penile tumescence testing) are eligible.