andrew1959nj wrote:Today I got a rejection letter from Aetna for my new cock. I'm submitting a Review Request it as I meet all of their stated parameters outlined in Aetna's Clinical policy Bulletin number: 0007
Andrew,
I am also covered by Aetna thru my employer and Aetna approved my implantat the end of August so I was implanted on 9/5.
I also looked at Aetna’s bulletin and it looks to me, your implant should be covered.
My defaults to different category as radical prostatectomy, Radical cystectomy, Surgery for colon Ca etc and implant is considered as restorative procedure caused by surgeries to remove Ca from above mentioned organs.
Just make sure your surgeon is using right ICD10 and CPT codes.
Good ICD10 code would be N52.02 which means ED of organic origin caused by veno-occlusive disorder.
CPT codes should be 54405 which means inserting of multi component penile prosthesis (cylinders, pump, reservoir)
I hope this might help.
MK