Does My Insurance Cover Penile Implants?

Penile Implant Insurance

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.

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

You Might Also Enjoy...

Am I a Good Candidate for a Penile Implant?

Am I a Good Candidate for a Penile Implant?

Have you wondered if a penile implant could be the right solution for your erectile dysfunction? In this post we describe the two types of penile implants, as well as when implants are likely to be the best solution.
6 Potential Causes of Urethral Strictures

6 Potential Causes of Urethral Strictures

A urethral stricture can cause serious issues, both for your quality of life and your health. In this post we discuss the six most common causes of urethral strictures as well as some of the most successful treatment approaches.
What to Expect After Buried Penis Surgery

What to Expect After Buried Penis Surgery

Buried penis is a condition that can have a profound effect on your life, for both physical and psychological reasons. Surgery is an effective treatment, but you may be worried about what to expect during recovery. Here’s what you need to know.