Prior Auth Required

54416 - Removal and replacement of non-inflatable Non-covered Service Benefit Exception Considered non-covered unless

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceRemoval and replacement of non-inflatable Non-covered Service Benefit Exception Considered non-covered unless
Procedure / Service Description

Code Description Plan Review Requirement Reviewed For Records Request - prosthesis, without replacement of prosthesis 54416 Removal and replacement of non-inflatable Non-covered Service Benefit Exception Considered non-covered unless (semi-rigid) or inflatable (self-contained) member's contract indicates coverage. penile prosthesis at the same operative

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.