Nerve Graft to Restore Erectile Function During Radical Prostatectomy
Defines UnitedHealthcare's coverage stance for autologous or allogenic nerve grafts (e.g., sural nerve grafting) performed to restore erectile function during or after radical prostatectomy; applies to UnitedHealthcare plans except state-specific exceptions listed.
No material clinical or coverage changes in this revision.
Coverage Determination
Not medically necessary
Covered when ALL of the following are met:
This is the explicit policy coverage rationale.
This policy does not apply to all UnitedHealthcare plans in every state. Refer to state-specific policies where noted for Idaho, Kansas, Kentucky, Louisiana, New Jersey, New Mexico, Ohio, Pennsylvania, Tennessee, and Indiana for applicable local guidance and coverage determinations.
Autologous (for example, sural) or allogenic nerve grafts performed to restore erectile function during or after radical prostatectomy are considered not medically necessary because the evidence is insufficient to demonstrate efficacy.
Applicable Procedure and Billing Codes
| 55899 | Unlisted procedure, male genital system. |
| 64999 | Unlisted procedure, nervous system |
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