DESCRIPTION
The pharmacological response test is performed by administering intracavernosal injections of a vasoactive drug. The injection should produce a sustained erection of 30 minutes duration. The absence of an erection is indicative of a vascular abnormality. An incomplete or rapid loss of an erection indicates venous incompetence. Both types of abnormal responses indicate a need for more detailed vascular studies. A rigid or nearly rigid erectile response indicates adequate arterial and veno-occlusive function. This diagnostic technique is also used to determine if the individual is a suitable candidate for penile injection therapy.
POLICY
The pharmacological response test for the diagnosis of erectile dysfunction is considered medically necessary.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Failure to respond adequately may be secondary to an individual's anxiety and discomfort, and not vascular insufficiency.
SOURCES
Agency for Health Care Policy and Research. (1990). Diagnosis and treatment of impotence. Retrieved August 6, 2001 from http://www.ahcpr.gov/clinic/impot2.htm.
American Urological Association. (2005) AUA guideline on the management of erectile dysfunction: Diagnosis and treatment recommendations. Retrieved February 7, 2008 from http://www.auanet.org/guidelines/edmgmt.cfm.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Erectile Dysfunction (2.01.25). Retrieved February 7, 2008 from BlueWeb.
Complete Guide to Medicare Coverage Issues [Computer software]. (2007, November). Diagnosis and treatment of impotence (NDC 230.4, p. 2-183). St. Anthony Publishing.
Cormio, L., Nisen, H., Selvaggi, F. P., & Ruutu, M. (1996). A positive pharmacological erection test does not rule out arteriogenic erectile dysfunction. Journal of Urology, 156 (5), 1628-1630. Abstract retrieved August 7, 2001 from PubMed database.
Erdogru, T., Kadioglu, A., Cayan, S., & Tellaloglu, S. (1997). Does the positive intracavernous papaverine test always indicate a normal penile vascular system? European Urology, 31 (3), 323-328. Abstract retrieved August 7, 2001 from PubMed database.
McMahon, C. G. (1995). An attempt to standardize the pharmacological diagnostic screening of vasculogenic impotence with prostaglandin E1. International Journal of Impotence Research, 7 (2), 83-90. Abstract retrieved January 1, 2000 from PubMed database.
National Institutes of Health. (1992). Consensus Development Conference Statement: Impotence. Retrieved August 6, 2001 from http://consensus.nih.gov/1992/1992Impotence091PDF.pdf.
Sogari, P. R., Teloken, C., & Souto, C. A. (1997). Atropine role in the pharmacological erection test: study of 228 patients. Journal of Urology, 158 (5), 1760-1763. Abstract retrieved January 26, 2000 from PubMed database.
ORIGINAL EFFECTIVE DATE: 4/27/1998
MOST RECENT REVIEW DATE: 3/27/2008
ID_BT
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.
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