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ICD-10-CM N52.9, Male erectile dysfunction, unspecified | No Prior Auth

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`N52.9`, Male erectile dysfunction, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must document medical necessity and meet the reasonable and necessary requirements specified in Novitas LCD L35050.
WatchPAT studies must be billed using CPT 95800 or 95801; actigraphy/CPAP documentation should be billed with CPT 95803 when used for NCD CPAP documentation or when accepted by the DME contractor.
Providers must check NCCI edits and follow NCCI correct coding guidelines before billing; this policy does not override NCCI.
Documentation that the patient's diagnosis meets one of the covered indications (e.g., chronic neck pain or chronic headache with minimum 12 weeks duration where applicable).

Key Coverage Criteria

Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.
Home sleep testing performed with a WatchPAT device should be billed with CPT code 95800 or 95801.
Actigraphy may be reported with CPT code 95803 to document CPAP coverage under the applicable NCD or as follow-up CPAP administration when accepted by the DME contractor.
Plantar Fasciitis
Peptic Ulcer
Post-Operative Ileus

9 Active Policies

NOVITAS-JH-L35050, Outpatient Sleep Studies

JH

NOVITAS-JL-L35050, Outpatient Sleep Studies

JL

A56923, Billing and Coding: Outpatient Sleep Studies

JL

AETNA-CPB-0135, Acupuncture and Dry Needling

AETNA-CPB-0262, Enhanced External Counterpulsation (EECP)

Related Codes

N52.01(8 policies)N52.31(4 policies)G47.30(4 policies)G47.8(4 policies)N52.1(4 policies)N52.2(4 policies)G47.33(4 policies)N52.39(4 policies)

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Documentation of duration of symptoms when chronicity is required (policy explicitly requires minimum 12 weeks duration for chronic neck pain and chronic headache).

Documentation of clinical response: if no clinical benefit after four weeks of acupuncture, the treatment plan should be reevaluated; further treatment is not medically necessary if the member does not demonstrate meaningful improvement in symptoms.

AETNA-CPB-0327, Infertility

AETNA-CPB-0416, Nerve Grafting and Reconstruction: Selected Indications

AETNA-CPB-0763, Homocysteine Testing

AETNA-CPB-0007, Erectile Dysfunction and Peyronie's Disease