Erectile_Dysfunction_Reimbursement_Policy
Defines which laboratory tests meet or do not meet coverage criteria for the diagnosis and evaluation of erectile dysfunction (ED), includes guidance on assay standardization and references to guideline recommendations and regulatory notes. Applies to plan benefit determinations with Medicare/Medicaid overrides noted.
EFFECTIVE DATE 7/1/2023 - Adopted Avalon policy recommendation
Coverage summary
Subject: Laboratory testing for diagnosis and evaluation of erectile dysfunction (ED). Purpose: to define which laboratory tests meet coverage criteria and which do not for the evaluation of ED and to provide guidance on assay standardization and related recommendations. Applicability: these coverage criteria apply to plan benefit determinations for laboratory testing used in the diagnosis and evaluation of ED; application depends on an individual’s benefit coverage at the time of request. Note: Medicare and Medicaid specifications may override this policy and, when there is a conflict, the applicable government policy will be used to make determinations.
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