Abstract
Inflatable penile prosthesis (IPP) has become an important treatment modality for men with erectile dysfunction (ED) that is refractory to medication. Despite high levels of patient satisfaction following IPP placement and IPP coverage by Medicare, coverage by commercial insurance providers is unknown. The purpose of this study was to determine the coverage of IPP by commercial insurance providers.
Following IRB approval, all men with ED interested in obtaining IPP at our tertiary care center between January 2016 and December 2017 were evaluated. We reviewed billing records for CPT code 54405 during the study period to evaluate the insurance provider for all men who received IPP. We also reviewed a manually maintained record of excluded or denied IPP claims for men who desired IPP but could not obtain IPP. Through medical record review we recorded the etiology of ED and the specific type of insurance policy for each man.
Medicare is the most common insurer of IPP, insuring 87 of 220 (39.5%) men seeking IPP between 2016 and 2017. Among the remaining 127 men seeking IPP with commercial insurance coverage, 61 (48.0%) were unable to obtain IPP due to exclusions in their coverage or denials. Among commercially insured men seeking IPP, 77 (62.6%) and 37 (30.0%) had Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans respectively. The most prevalent indications for IPP among the entire study population were status-post radical prostatectomy (30.9%), organic ED (30.5%), and diabetes mellitus (20.9%).
The largest insurer of IPP in the Miami region is Medicare. While patients seeking IPPs can receive insurance coverage, a large percentage (48.0%) of patients are not able to receive coverage despite having a medical necessity for treatment of ED.
