CurrentColorado Rocky Mountain Health PlansPolicy 2026T0372BB

Nerve Graft to Restore Erectile Function During Radical Prostatectomy

Defines UnitedHealthcare's stance on autologous or allogeneic nerve grafts (e.g., sural) performed during or after radical prostatectomy to restore erectile function; applies to UnitedHealthcare Commercial and Individual Exchange benefit plans.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyNerve Graft to Restore Erectile Function During Radical Prostatectomy

Policy CodePolicy 2026T0372BB

Change TypeNo material change

Effective DateJan 1, 2026

Next Review Date

Key ActionReference the member-specific benefit plan and applicable mandates before pursuing authorization; procedure codes listed are for reference and do not imply coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InsufficientConclusion on efficacy

Commercial & ExchangePlans applicable

113Prospective study size

1 trialRandomized evidence

NCCN 2025Guideline ref

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Coverage Determination

Not medically necessary

Covered when ALL of the following are met:

Primary coverage determination: Autologous or allogenic nerve grafts to restore erectile function during or after radical prostatectomy are considered unproven and not medically necessary due to insufficient evidence of efficacy.

Policy applies to UnitedHealthcare Commercial and Individual Exchange plans.

Clinical evidence and guideline summary

Summary of clinical evidence and guideline recommendations:

Evidence from observational studies: A prospective observational study (Namiki et al. 2007) of 113 patients reported faster early recovery of continence and better sexual function scores with bilateral nerve-sparing versus unilateral nerve-sparing with sural nerve grafting, but differences were not significant by 24 months; study lacked randomization.

supports limited/uncertain benefit

Guideline position: NCCN (Prostate cancer v2.2025) states that replacement of resected nerves with nerve grafts does not appear to be effective for patients undergoing wide resection of the neurovascular bundles.

guideline recommends against effectiveness in wide resection

Autologous (e.g., sural) or allogenic nerve grafting procedures performed to restore erectile function during or after radical prostatectomy are not considered medically necessary. The available evidence is insufficient to demonstrate efficacy for restoration of erectile function and therefore these procedures are considered unproven and not medically necessary.

The NCCN prostate cancer guideline notes that recovery of erectile function after radical prostatectomy is related to preservation of the cavernous nerves, patient age, and baseline erectile function, and specifically states that replacement of resected nerves with nerve grafts does not appear to be effective for patients undergoing wide resection of the neurovascular bundles (NCCN, 2025).

Autologous (for example, sural) or allogenic nerve grafts to restore erectile function during or after radical prostatectomy are considered unproven. The clinical literature provides insufficient high-quality evidence of benefit, and available randomized data were stopped early for lack of demonstrated benefit, supporting the conclusion that these approaches are not medically necessary.

Supporting guideline guidance: the NCCN statement reinforces that replacement of resected nerves with nerve grafts does not appear to be effective in patients who have undergone wide resection of the neurovascular bundles, providing a guideline-based reason to consider the procedure ineffective in that setting.

Provider Actions and Rationale

Billing Rule

Code Reference and Authorization Guidance

The following procedure and diagnosis codes are provided for reference only and do not by themselves determine coverage or payment. Listing of a code in this policy does not imply that the service described by the code is a covered or non‑covered health service. Always verify member-specific coverage and reimbursement policies.

55899 - Unlisted procedure, male genital system
64999 - Unlisted procedure, nervous system

Prior Authorization

Verify benefit plan and prior authorization processes

Before applying this policy, verify the member-specific benefit plan document and any applicable federal or state mandates. In the event of a conflict between this policy and the member-specific benefit plan, the benefit plan governs. Confirm whether prior authorization is required for the service under the member's plan and follow the plan's authorization process.

Applicable Codes (Reference Only)

Applicable Codes (reference only)CPT

55899	Unlisted procedure, male genital system
64999	Unlisted procedure, nervous system

Background

Erectile dysfunction commonly occurs following radical prostatectomy, particularly when the cavernous neurovascular bundles are resected. Nerve-sparing surgical approaches aim to preserve erectile function, but are not always feasible; nerve grafting (such as sural nerve grafting) has been proposed to bridge resected cavernous nerves in an attempt to restore spontaneous erectile function. However, clinical evidence is limited and does not conclusively demonstrate improved long-term erectile outcomes with nerve grafting.

Definitions

Sural nerve grafting (SNG) — definition

TermSural nerve grafting (SNG)

DefinitionHarvesting a segment of the sural nerve (from the lower leg) and grafting it to the resected cavernous nerve during radical retropubic prostatectomy to attempt restoration of erectile function.

Donor nerve detailsSural nerve travels along the short saphenous vein in the lower leg and is considered expendable; commonly used as the donor in these procedures.

Procedure approachA portion of the sural nerve is harvested from one leg and joined to the distal and proximal ends of the resected cavernous nerve; grafting may be unilateral or bilateral.

Clinical intentProposed to increase likelihood of restoring spontaneous erectile function after resection of cavernous nerves during radical prostatectomy.