CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Nerve Graft with Radical Prostatectomy

This policy governs coverage for unilateral or bilateral nerve grafting (most commonly sural nerve) performed at the time of radical prostatectomy for recovery of erectile function. It applies to Blue Cross Blue Shield - Rhode Island members and providers submitting claims for this procedure.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNerve Graft with Radical Prostatectomy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 5, 2021

Next Review DateN/A

Key ActionDo not bill as covered for patients with resection of one or both neurovascular bundles; verify member-specific benefits and use CPT 64999 to describe the nerve grafting component if performed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1randomized controlled trial identified

64999no specific CPT

4clinical input respondents

NCCNguideline note

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Not medically necessary when neurovascular bundles resected

Not covered when neurovascular bundles are resected — Coverage determination:

Not covered when neurovascular bundles resected: Unilateral or bilateral nerve grafting (e.g., sural nerve grafting) is considered not covered / not medically necessary for patients who have had resection of one or both neurovascular bundles as part of a radical prostatectomy because the evidence is insufficient to determine effects on health outcomes.

Supported by randomized and observational evidence showing no clear benefit; NCCN states replacement of resected nerves has not been shown to be beneficial.

Unilateral or bilateral nerve grafting performed at the time of radical prostatectomy is not covered / not medically necessary for patients who have had resection of one or both neurovascular bundles. The policy states that the evidence is insufficient to determine effects on health outcomes when neurovascular bundles are resected and therefore does not support coverage.

In summary, nerve grafting (most commonly sural nerve) at the time of radical prostatectomy is considered not covered / not medically necessary for patients with resection of one or both neurovascular bundles because available evidence — including randomized and observational studies — has not demonstrated clear benefit in restoring erectile function or other meaningful health outcomes.

Provider Actions & Billing Notes

Prior Authorization

Prior Authorization Required

Provider must verify member-specific prior authorization requirements with Blue Cross Blue Shield of Rhode Island before scheduling the procedure. Prior authorization may be required depending on the member's plan and contract; contact the plan's provider services or check the member's Benefit Booklet/Evidence of Coverage for authorization details.

Check member-specific benefits and prior authorization portals
Contact provider services for prior authorization determination

Denial Risk

Coverage Denial Risk

Unilateral or bilateral nerve grafting is considered not covered / not medically necessary for members who have had resection of one or both neurovascular bundles as part of a radical prostatectomy. If documentation shows neurovascular bundle resection, the procedure is at high risk for coverage denial.

Procedure considered not covered/not medically necessary when neurovascular bundles were resected during radical prostatectomy
Provide operative notes and clinical documentation if submitting for review to demonstrate nerve status

Billing Rule

Coding and Billing Note

For billing, use CPT 64999 (unlisted procedure, nervous system) to report the sural nerve harvest and grafting component, since there is no specific CPT code for cavernous nerve grafting. Verify member benefits and include supporting documentation with the claim.

Use CPT 64999 for nerve grafting component
Include operative and pathology reports to support medical necessity when applicable

Background

Erectile dysfunction is common after radical prostatectomy, particularly when bilateral neurovascular bundles are resected, and many patients prefer restoration of spontaneous erectile activity. Sural nerve grafting has been proposed as a technique to replace divided cavernous nerves by harvesting a segment of the sural (or other expendable) nerve and anastomosing it to the divided cavernous nerve ends. Clinical evidence evaluating this approach includes one randomized controlled trial, cohort studies, and case series; the randomized trial did not show a statistically significant improvement in potency with unilateral grafting, and overall evidence is insufficient to demonstrate meaningful benefit.

Definitions

Sural nerve grafting — definition/description

Procedure descriptionHarvesting a segment of the sural nerve (from one leg) and anastomosing it to the divided ends of the cavernous nerves at the time of radical prostatectomy to attempt restoration of erectile function.

Anatomic detailsSural nerve is considered expendable and has been used in other nerve grafting procedures; graft connects harvested sural nerve to cavernous nerve ends after resection.

Typical indicationOffered at time of radical prostatectomy to attempt recovery of spontaneous erectile function when cavernous nerves are divided or damaged.

Alternative donor nervesOther donor nerves (e.g., genitofemoral nerve) have been reported for grafting, though sural nerve is most commonly used.

Evidence summaryEvidence includes one randomized controlled trial, cohort studies, and case series; available studies have not shown clear benefit in potency recovery.