Does Medicare Cover Penile Implants?
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Penuma Implant Eligibility
August 10, 2021
A common question received at our South Florida urology office is whether Medicare will cover a penile implant procedure. The offices of Dr. Edward Gheiler, one of only ten urology surgeons trained in the penuma implant procedure, would like to offer some insight into whether Medicare covers penile implant procedures and, if so, to what extent.
Does it?
In short, yes. Medicare does provide coverage for penile implants if a patient meets certain requirements. Coverage and patient costs will vary based on the specific patient and if a patient also has supplemental or secondary coverage.
Medicare Requirements for Covering Penile Implants
There are a variety of penile implants. Medicare will only cover those intended to provide treatment for erectile dysfunction. Our penuma implant procedure, for example, is a penis enhancement surgery that Medicare would not cover. However, other implant procedures, such as the semi-rigid or inflatable penile implant, may be covered by Medicare if the patient meets the following requirements.
For Medicare to cover this procedure, a patient will have to prove that non-invasive treatments for erectile dysfunction, such as oral medication, penile injection, and vacuum erection devices, could not provide effective solutions.
In addition to these treatments not working, a doctor must diagnose the cause of erectile dysfunction as being organic rather than psychogenic.
What Is the Cost of Penile Implants With Medicare?
The cost of the penile implant will vary by the specialist you select; however, there is some general information that will apply to a patient with Medicare.
Penile implants are an outpatient procedure, meaning that they would be covered under Medicare Part B coverage. Therefore, if you have met your deductible, your cost will be 20% of all charges relating to the procedure. This may be less if you have secondary or supplemental coverage. Charges will include the cost of surgeon and facility and additionally might include costs associated with testing and additional services if required.
Patient costs will also differ based on where they seek treatment. This refers to geographic location, as well as where they are receiving the procedure. Medicare coverage varies by region, and costs will vary based on if the patient chooses a hospital, specialist, or ambulatory surgery center.
Generally, a hospital will provide the most costly procedure, meaning the 20% owed by the patient will be quite high. Ambulatory surgery centers are also quite costly and will incur a high cost for the patient. Specialists generally provide the most cost-effective solutions, in addition to having greater experience with the procedures.
Scheduling Your Penile Implant Procedure
If you have any further questions regarding your Medicare coverage on a penile implant procedure, be sure to contact the Medicare service department.
If you are searching for a qualified urologist in South Florida, we recommend visiting our Fort Lauderdale office. With over twenty years of experience in urological services, our offices will provide you with the solutions you need. Contact us today to find out more on costs and insurance coverage and to schedule your procedure.
