242 Commercial Insurance Coverage for Inflatable Penile Prosthesis at a Tertiary Care Center

Abstract

Inflatable penile prosthesis (IPP) has become an important treatment modality for men with erectile dysfunction (ED) that is refractory to medication. Despite high levels of patient satisfaction following IPP placement and IPP coverage by Medicare, coverage by commercial insurance providers is unknown. The objective of this study was to determine the coverage of IPP by commercial insurance providers. All men with ED interested in obtaining IPP at our tertiary care center between January 2016 and December 2017 were evaluated. We reviewed billing records for current procedural terminology (CPT) code 54405 during the study period to evaluate men who received IPP. We also reviewed a manually maintained record of excluded or denied IPP claims for men who desired IPP but could not obtain IPP. We excluded men who received repair or replacement of an existing penile prosthesis. Medicare is the most common insurer of IPP, insuring 76 of 200 (38.0%) men seeking IPP between 2016 and 2017. Among the remaining 124 men seeking IPP with commercial insurance coverage, 61 (49.2%) were unable to obtain IPP due to exclusions in their coverage or denials. Among the men who had exclusions in their insurance policies or were denied, 47 (77.0%) were status-post radical prostatectomy, 36 (59%) had organic ED, and 27 (44.3%) were diabetic.