Prior Auth Required

54401 - Insertion of penile prosthesis; inflatable 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; inflatable Non-covered Service Benefit Exception Submit records only when member's
Procedure / Service Description

transition/affirmation surgery unless - transition/affirmation surgery unless otherwise specified by contract. 54401 Insertion of penile prosthesis; inflatable Non-covered Service Benefit Exception Submit records only when member's (self-contained) 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.