Prior Auth Required

54400 - Insertion of penile prosthesis; non- Non-covered Service Benefit Exception Submit records only when member's

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceInsertion of penile prosthesis; non- Non-covered Service Benefit Exception Submit records only when member's
Procedure / Service Description

documentation of medical necessity, - 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 inflatable (semi-rigid) contract indicates coverage. Beginning 1/1/22 code will require review for WA

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.