Are penile implants covered by insurance?

Yes, penile implants are covered by Medicare and most private insurance plans. Dr. Chung’s office will work with your insurance company to conduct a thorough evaluation.

Am I able to check coverage with my insurance company?

Yes, you may also contact your insurance company to evaluate coverage. Many insurance companies may have the option to check coverage online. You will need diagnosis (ICD-10) and procedure (CPT) codes to help with your search. Below are common codes used for penile implant surgery that may apply to you.

ICD-10 Codes

F52.21 Male erectile disorder
N52.01 Erectile dysfunction due to arterial insufficiency
N52.31 Erectile dysfunction following radical prostatectomy
N52.32 Erectile dysfunction following radical cystectomy
N52.35 Erectile dysfunction following radiation therapy

CPT Codes

54400 – Insertion of a semi-rigid, malleable, or non-inflatable penile implant
54405 – Insertion of an inflatable penile implant
54408 - Repair of component(s) of an inflatable penile implant
54416 – Removal and replacement of a non-inflatable or inflatable penile implant at the same operative setting

What if my insurance does not cover penile implants?

Unfortunately, not all insurance plans cover penile implants. Dr. Chung’s office will work to help support your case with phone calls and even letters of support to your insurance company. Patients who are not covered may work with Dr. Chung’s office to evaluate other payment options such as self-pay or payment plans. Some patients may be eligible, but have not yet applied for Medicare. Other patients may have served in the Armed Forces and may be eligible for Tri-Care. Contact us to schedule an appointment with Dr. Chung.

Author

Paul H. Chung, MD Paul H. Chung, MD is Assistant Professor of Urology and Director of Reconstructive Urology at the Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA