PURPOSE
To establish a basis for determining the medical necessity of testing and treatment for individuals with erectile dysfunction.
DESCRIPTION
Erectile dysfunction, also called impotence, is the inability of the male to achieve and / or maintain an erection sufficient to enable penetration. Erectile dysfunction can be a secondary symptom of systemic diseases or its treatment, such as diabetes mellitus, hypertension, blood lipid abnormalities, or peripheral vascular disease. Other causes of erectile dysfunction may be psychogenic in origin or caused by penile trauma, spinal cord injuries, abnormalities of the penis (such as penile fibrosis and Peyronie's' disease), venous occlusive dysfunction, or as a result of a radical pelvic surgery (such as radical prostatectomy or cystectomy). Alcohol consumption, drugs, and smoking may contribute to erectile dysfunction.
Psychogenic impotence is defined as impotence related to an emotional or psychological origin such as stress, depression, or anxiety.
POLICY
BlueCross BlueShield of Tennessee recognizes the need for consistency in the determination of medical appropriateness for testing and treatment of erectile dysfunction.
Services will be considered medically appropriate only if they have met BlueCross BlueShield of Tennessee's technology evaluation criteria.
|
*** |
THE FOLLOWING POLICIES HAVE BEEN |
*** |
|
|
REVIEWED. PLEASE REFER TO THE POLICY |
|
|
*** |
TO DETERMINE MEDICAL APPROPRIATENESS. |
*** |
DIAGNOSTICS:
THERAPEUTICS:
ADDITIONAL INFORMATION
A comprehensive physical examination, medical/sexual history and psychosocial evaluation must be done as a part of any evaluation for erectile dysfunction.
ORIGINAL EFFECTIVE DATE: 4/27/1998
MOST RECENT REVIEW DATE: 9/22/2011
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.