ModifiedUnitedHealthcarePolicy CSNCT0372.04

Nerve Graft to Restore Erectile Function During Radical Prostatectomy (for North Carolina Only)

Policy governing use of autologous or allogenic nerve grafts to restore erectile function during or after radical prostatectomy for members in North Carolina.

Policy Summary

PayerUnitedHealthcare

PolicyNerve Graft to Restore Erectile Function During Radical Prostatectomy (for North Carolina Only)

Policy CodePolicy CSNCT0372.04

Change TypeContent updates and operational coding note

Effective DateDec 1, 2025

Next Review DateN/A

Key ActionVerify plan and state-specific coverage and prior authorization requirements before performing cavernous nerve reconstruction or submitting claims.

SourceLink

POLICY UPDATE CHANGES

Added notation that CPT codes 55899 and 64999 are not on the State of North Carolina Medicaid Fee Schedule and therefore are not covered by the State of North Carolina Medicaid Program.

Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect the most current information.

Archived previous policy version CSNCT0372.03.

North CarolinaApplies only to

Not medically necessaryCoverage stance

2 CPTCodes listed

55899, 64999

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.

Small studiesEvidence

Coverage Criteria

Policy coverage stance

Not covered — procedures are considered unproven and not medically necessary.

Autologous (e.g., sural) or allogenic nerve grafts to restore erectile function during or after radical prostatectomy are unproven and not medically necessary due to insufficient evidence of efficacy.

There is insufficient quality scientific evidence demonstrating that nerve grafting results in improved erectile function outcomes following radical prostatectomy; available data are limited to single-arm and nonrandomized observational studies and one randomized trial that ended early for lack of benefit.

Because the intervention is considered unproven and not medically necessary, procedures for cavernous nerve reconstruction using autologous or allogenic nerve grafts are at risk for claim denial and are not covered under this policy.

Autologous (e.g., sural) or allogenic nerve grafts performed to restore erectile function during or after radical prostatectomy are considered unproven and not medically necessary due to insufficient evidence of efficacy.

Nerve grafting to restore erectile function is judged not medically necessary because the available clinical evidence is limited and of insufficient quality. Most published reports are single-arm or nonrandomized observational studies that may be biased by baseline differences between patients who did and did not receive grafting. A randomized trial was stopped early after an interim analysis showed no benefit, further undermining confidence in efficacy; collectively, the data do not demonstrate consistent, high-quality improvement in erectile function after nerve grafting.

Operational coding note for North Carolina: CPT codes 55899 and 64999 are not on the State of North Carolina Medicaid Fee Schedule and therefore are not covered by the State of North Carolina Medicaid Program.

Applicable Codes

Applicable CPT Codes (listed for reference)CPT

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

Not covered on NC Medicaid Fee ScheduleCPTNot Covered

55899	Unlisted procedure, male genital system (not on NC Medicaid Fee Schedule per policy note)
64999	Unlisted procedure, nervous system (not on NC Medicaid Fee Schedule per policy note)

State Medicaid Fee Schedule inclusion — NC Medicaid coding note

State Medicaid Fee Schedule inclusionCPT codes 55899 and 64999 are not on the State of North Carolina Medicaid Fee Schedule

Codes listed in policy55899: Unlisted procedure, male genital system; 64999: Unlisted procedure, nervous system

ImplicationCodes marked with an asterisk in the policy may not be covered by the State of North Carolina Medicaid Program

Provider Actions and Billing Notes

Denial Risk

Denial risk for nerve grafting

Autologous or allogenic nerve grafting to restore erectile function (e.g., during or after radical prostatectomy) is considered unproven and not medically necessary. Claims for these procedures may be denied.

Procedures such as nerve grafting for erectile function restoration are considered unproven and may be subject to denial.

Billing Rule

Coding denial risk for NC Medicaid

CPT codes 55899 and 64999 are not listed on the State of North Carolina Medicaid Fee Schedule and therefore may not be covered by NC Medicaid. Providers should expect that claims billed under these unlisted procedure codes may be rejected or denied by NC Medicaid.

Background

Erectile dysfunction (ED) is a common consequence of radical prostatectomy, particularly when bilateral resection of the neurovascular bundles occurs. While nerve-sparing techniques aim to preserve cavernous nerve function, resection may be unavoidable in some cases. Autologous approaches such as sural nerve grafting and other reconstructive techniques have been proposed to replace resected cavernous nerves and restore spontaneous erectile function, but the clinical benefit remains unproven.

Definitions

Sural nerve graft (SNG)

TermSural nerve graft (SNG)

DefinitionAutologous donor nerve procedure in which a segment of the sural nerve is harvested from the lower leg and grafted to the resected cavernous nerve during radical prostatectomy

Donor nerve detailsSural nerve travels along the short saphenous vein in the lower leg and is considered expendable for grafting

Unilateral interposition sural nerve graft — technique definition

TermUnilateral interposition sural nerve graft

DefinitionA technique in which a portion of the sural nerve is harvested from one leg and interposed (grafted) to a single resected cavernous nerve to attempt cavernous nerve reconstruction after radical prostatectomy

Revision History

2025-12-01revisionLatest

Added notation that CPT codes 55899 and 64999 are not on the State of North Carolina Medicaid Fee Schedule and therefore are not covered by the State of North Carolina Medicaid Program; supporting sections (Description of Services, Clinical Evidence, FDA, References) updated and previous version CSNCT0372.03 archived.

Policy Summary

PayerUnitedHealthcare

PolicyNerve Graft to Restore Erectile Function During Radical Prostatectomy (for North Carolina Only)

Policy CodePolicy CSNCT0372.04

Change TypeContent updates and operational coding note

Effective DateDec 1, 2025

Next Review DateN/A

Key ActionVerify plan and state-specific coverage and prior authorization requirements before performing cavernous nerve reconstruction or submitting claims.

SourceLink

On This Page

CPT 55899 — Unlisted procedure, male genital system

CPT 64999 — Unlisted procedure, nervous system

Denial Risk

NC Medicaid coding denial risk (operational)

Explicit operational note: claims submitted to North Carolina Medicaid using CPT 55899 or CPT 64999 will not be covered by the NC Medicaid Program per the State fee schedule. Do not assume payment; verify alternative covered codes or obtain plan guidance before billing.

NC Medicaid will not cover CPT 55899 and CPT 64999 — claims may be denied/returned by the payer.

Prior Authorization

Verify plan/state coverage & prior authorization

Prior authorization and coverage can vary by plan, contract, and state; this policy lists codes for reference only and listing does not guarantee coverage. Verify plan- and state-specific coverage and any prior authorization requirements before performing services or submitting claims.

Check federal, state, and contractual requirements that govern the member's benefit plan.
Confirm whether prior authorization is required with the member’s UnitedHealthcare plan or delegated entity.

Step Therapy

Step therapy

No step therapy requirements are specified in this policy section.

Documentation Required

Documentation and coding note

Listing of procedure or diagnosis codes in this policy is for reference only and does not imply coverage. Document services thoroughly and ensure coding and clinical documentation meet the member’s plan, federal, and state requirements.

Inclusion of a code does not guarantee reimbursement or claim payment.
Maintain clinical documentation demonstrating medical necessity consistent with plan and regulatory requirements.

Documentation Required

Plan- and state-specific documentation check

Providers must check and document compliance with applicable federal, state, and contractual documentation requirements when submitting claims. If the member is covered by a state Medicaid program, follow the state’s billing rules and fee schedule.

Confirm and document adherence to federal/state/contractual requirements prior to claim submission.
Retain supporting clinical records in case of audit or claim review.

Note

Miscellaneous provider action

Additional provider actions may apply based on the member’s specific plan or delegated administrative requirements. Contact the plan’s provider service resources for any situational instructions not covered here.

When in doubt, contact UnitedHealthcare provider services or the member’s plan administrator.

ApplicationGrafting may be performed on one or both resected cavernous nerves; the unilateral interposition describes grafting to one side only