Prior Auth Required

54250 - Nocturnal penile tumescence and/or rigidity Non-covered Service Benefit Exception Considered non-covered unless

This procedure appears on the selected insurer prior authorization source.

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Procedure / ServiceNocturnal penile tumescence and/or rigidity Non-covered Service Benefit Exception Considered non-covered unless
Procedure / Service Description

documentation of medical necessity, - 54240 Penile plethysmography Non-covered Service Benefit Exception Considered non-covered unless member's contract indicates coverage. 54250 Nocturnal penile tumescence and/or rigidity Non-covered Service Benefit Exception Considered non-covered unless test member's contract indicates coverage. 54400 Insertion of penile prosthesis; non- Non-covered Service Benefit Exception Submit records only when member's

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.