CommercialCoverageMedium impact
Erectile Dysfunction 7.01.30
Excellus BlueCross BlueShield·Urology·Urinary System (Genitourinary)
Effective date
Oct 16, 2025
We identified it
Jun 20, 2026
Summary
New Excellus BlueCross BlueShield policy defines medical necessity criteria for erectile dysfunction diagnosis and treatment, requiring 6+ months of symptoms for treatment coverage and establishing covered vs. non-covered diagnostic procedures and treatment modalities.
Action Required
By October 16, 2025: Billing team must ensure documentation supports 6+ month symptom duration for ED treatment claims (except for acute cases like penile trauma or post-surgical ED). Update prior authorization requests to include medical necessity statements from urologists for all non-oral ED treatments. Verify coverage limitations for investigational treatments like ESWT and penile contracture devices which will be denied.