Archived Policies - Surgery
Evaluation of Impotence
Evaluation of Impotence MAY BE ELIGIBLE FOR COVERAGE for the following diagnostic studies after a complete history and physical (medical and sexual) has been completed. These diagnostic studies include, but are not limited to, the following:
Penile Plethysmography IS NOT ELIGIBLE FOR COVERAGE as this diagnostic testing has been replaced by newer, more accurate assessments and measurements of penile blood flow.
Corpus Cavernosum Electromyography (CCEMG) and Single Potential Analysis of Cavernous Electrical Activity (SPACE) ARE NOT ELIGIBLE FOR COVERAGE as part of an evaluation of impotence as these diagnostic evaluations are considered investigational.
Evaluation of Impotence begins with a comprehensive history and physical examination. A careful sexual history and knowledge of concurrent illnesses and medications are essential. In addition, a clinical evaluation may include the following:
Considerable attention has been paid to the evaluation and treatment of sexual dysfunction due to the development of new drugs and procedures.
Erectile dysfunction or impotence can be a secondary symptom of systemic diseases or their treatment, such as diabetes mellitus, hypertension, blood lipid abnormalities, or peripheral vascular disease. Evaluation of impotence should include detailed medical and sexual history, physical examination, and basic lab studies. Further diagnostic studies may be required to assess:
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
Berkow, Robert M.D., and Andrew J. Fletcher, M.B., B.Chir., eds. 1992. The Merck Manual, 17th edition. New Jersey: Merck & C., Inc.: 1575-6.
NIH Consensus Conference. "Impotence. NIH Consensus Development Panel on Impotence." (1993 July 7) 270(1): 83-90.
"The Testis." 1995 Scientific American Medicine (CD Rom/on-line) Chapter II (1995 January): 1-22.
DeWire, D.M. "Evaluation and treatment of erectile dysfunction." American Family Physician (1996 May 1) 53(6): 2101-8.
Connolly, J.A., et al. "Ultrasound evaluation of the penis for assessment of impotence." Journal of Clinical Ultrasound (1996 October) 24(8): 481-6.
Borirakchanyavat, S. and Tom F. Lue. "Evaluation of Impotence." (1997) Infectious Urology 10(1): 12-5, 18-23, 29.
Wahl, S.I., et al. "Radiologic evaluation of penile arterial anatomy in arteriogenic impotence." International Journal of Impotence Research (1997 June) 9(2): 93-7.
"Erectile Dysfunction." BCBSA Consortium Health Plan Medical Policy Reference Manual (1997 June 30) Medicine: 2.01.25.
Aggour, A., et al. "Evaluation of the role of corpus cavernosum electromyography as a noninvasive diagnostic tool in male erectile dysfunction." International Urology and Nephrology (1998) 30(1): 75-9.
Timmermans, L. "Methodology of penile isotope imaging. Evaluation." ACTA Urologcia Belgica (1998 March) 66(1): 13-7.
|Title:||Effective Date:||End Date:|
|Sexual Dysfunctions, Assessment and Treatment||06-01-2017||06-14-2018|
|Sexual Dysfunctions, Assessment and Treatment||03-15-2016||05-31-2017|
|Sexual Dysfunctions, Assessment and Treatment||05-15-2015||03-14-2016|
|Sexual Dysfunctions, Assessment and Treatment||12-15-2014||05-14-2015|
|Sexual Dysfunctions, Assessment and Treatment||06-01-2012||12-14-2014|
|Sexual Dysfunctions, Assessment and Treatment||12-15-2010||05-31-2012|
|Sexual Dysfunctions, Assessment and Treatment||06-01-2008||12-14-2010|
|Sexual Dysfunctions, Assessment and Treatment||02-15-2007||05-31-2008|
|Treatment of Male Sexual Dysfunction||03-01-2000||02-14-2007|
|Evaluation of Impotence||09-01-1999||02-14-2007|