DESCRIPTION
Contrast material is injected into the pudendal arteries, or directly into the penile chambers, and followed by x-ray to determine the location of penile lesions. A vasoactive drug is injected prior to the test and general or regional anesthesia is required.
POLICY
Pudendal Arteriography for the diagnosis of erectile dysfunction is considered not medically necessary.
See also: Erectile Dysfunction - Penile Revascularization
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
Scientific evidence in the form of published articles in peer-reviewed journals are lacking regarding long-term outcomes and long-term adverse events.
SOURCES
American Urological Association (1996). Clinical practice guidelines. Report on the treatment of organic erectile dysfunction. Retrieved January 7, 2008 at http://www.auanet.org/guidelines/main_reports/ed.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Erectile Dysfunction (2.01.25). Retrieved January 7, 2008 from BlueWeb. (0 articles and/or guidelines reviewed)
National Guideline Clearinghouse. (2006, May). The management of erectile dysfunction: An update. Retrieved January 7, 2008 from http://www.guidelines.gov.
Sadeghi-Nejad, H. Brison, D., & Dogra, V. (2007). Male erectile dysfunction. Ultrasound Clinics, 2 (1), 57-71.
ORIGINAL EFFECTIVE DATE: 4/27/1998
MOST RECENT REVIEW DATE: 2/28/2008
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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