If you have an insurance plan that covers penile implant surgery, your doctor can work with you to address requirements that must be met prior to a procedure. If your insurance plan does not cover penile implants or if you have a benefit exclusion, you will be responsible for all charges related to the surgery.
Medicare or a Medicare Advantage Plan will typically cover a penile implant procedure if it is deemed medically necessary. Your doctor should be very familiar with their responsibility to document your treatment journey in your medical record. This record will aid in showing that a penile implant is medically necessary. It is proof that you need the device to treat impotence/ED.
The amount you may pay out-of-pocket will vary by plan (for example, Medicare or Medicare Advantage) and the type of facility where the penile implant procedure is performed. Surgery for a penile implant can be done at a hospital on an outpatient basis or in an ambulatory surgery center.
All penile implants manufactured by Boston Scientific (the AMS 700™ series implant and Tactra™ implant) are devices to treat ED. They may all be eligible for coverage under Medicare and Medicare Advantage when deemed medically necessary. To learn about your eligibility for coverage, talk to your insurance provider.
Insurance plans through your employer or health insurance that you’ve purchased yourself are often referred to as “commercial” plans. If a commercial insurance plan covers penile implant surgery, they may have specific coverage requirements that must be met. Others will determine coverage based on medical necessity. Some may exclude benefits for a penile implant altogether.
With this insurance, your employer chooses what benefits to cover. Some employers provide benefits for ED treatments and cover penile implant procedures. However, some employers exclude benefits for erectile dysfunction treatment and do not cover the penile implant as a treatment option.
If the penile implant is a benefit that is excluded (also called a benefit exclusion), you can call Boston Scientific’s Procedure Access Program at (855) 284-1676, option #1, to speak with a specialist that can provide you with information to support a request to your employer for a benefit exception.
If penile implant surgery is covered by your insurance, your doctor may have confirmed your benefits and obtained any necessary authorization from your insurance. However, this is not a guarantee of payment. You should contact your insurance plan directly to confirm your insurance benefits include coverage for a penile implant.
The contact information for your insurance plan is typically on the back of your insurance card. All penile implants manufactured by Boston Scientific (the AMS 700™ series implant and Tactra™ implant) are devices to treat ED. They qualify as reimbursable when an insurance plan covers penile implant surgery and you qualify for the benefit and coverage.
Keep in mind that how much you will pay out-of-pocket will vary. The cost you pay for a penile implant will differ depending upon your insurance plan and the type of facility where the procedure is done. Your co-pay, deductible, and co-insurance will determine your financial responsibility (the amount you will have to pay).
If penile implant surgery is not covered by your insurance, you will first need to determine the reason for non-coverage. Your insurance may have determined a penile implant was not medically necessary and therefore will not allow coverage. This is often called a “denial.” Or, the plan you have may not have benefit coverage for ED treatment and/or a penile implant. This is often referred to as a “benefit exclusion.”
TIP: You will need a copy of your full benefit plan booklet. These are often called a Summary Benefit Plan (SBP) or Summary Plan Description (SPD). You can typically get this large document from your employer’s personnel department or from your insurance plan website.
Individually purchased health insurance is also often called a “commercial” plan. It is like an employer-sponsored health plan. Read the section entitled “My insurance is through my employer” for an overview of how to proceed when your benefits cover penile implants for treating ED. The above section also tells you what to do when the insurance plan you have says you have non-coverage, or when benefits exclude coverage for erectile dysfunction treatment and/or penile implants.
State Medicaid and Medicaid Managed Care coverage may vary by state and by plan type. You should ALWAYS confirm your benefits before an implant procedure. If the penile implant is not covered by your state Medicaid or Medicaid Managed Care, you will be responsible for all charges related to the surgery.
All penile implants from Boston Scientific (the AMS 700™ series implant and Tactra™ implant) qualify as devices that treat ED where medically necessary. Medicaid plans that cover ED treatment will typically need for the implant procedure to be authorized. Your doctor’s office can help with this. Again, you will want to confirm your coverage details prior to the surgery.
When the insurance plan you have says that there is non-coverage for a penile implant or that you have a benefit exclusion for this ED treatment option, you can ask for a benefit exception.
Start by getting a copy of your Summary Benefit Plan (SBP) or Summary Plan Description (SPD). Then, work with your doctor's office for help.
Another option to consider is changing your insurance plan during open enrollment. If you make a change to your insurance, you will want to confirm the insurance plan you are evaluating covers ED treatment with a penile implant.
If you do not have health insurance right now and are ready to proceed with your penile implant procedure learn about your options.
Negotiated fee and financing options are often available. For example, you can let your doctor know that you will be paying for the surgery yourself. Ask your doctor if a financial assistance program is available. Alternatively, some clinics offer cash-pay discounts or a price break for timely or early payment.
If you are considering purchasing insurance in the future, you will want to research your plan options and learn which plans cover ED treatment, including penile implants.
The Mission Act replaced the Veteran’s Choice Program in 2018. This change allows veterans to receive medical care from physicians within the public sector. In order to receive medical care from a private physician, you first need to make an appointment with your VA physician to determine eligibility. It is important that the VA confirms eligibility before making an appointment with a community physician (outside the VA) in order to make this referral. Community physician charges should be similar to those from a VA physician.
For non-VA care, to determine eligibility for a penile implant procedure, it is important to have the procedure prior-authorized.
For patients with Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), the process is different from non-VA care. Pre-authorization for VAs should be handled by the veteran and Veterans Affairs. The veteran needs to obtain a referral and an authorization for care which is generated by the local non-VA medical care office. This is typically sent to the veteran and to the provider. You should have a copy of this prior to receipt of care.
Navigating health insurance coverage can be complicated. If a penile implant is not covered by your insurance, it may be considered a benefit exclusion. This simply means that the procedure is not included as one of your covered benefits.
For support with benefit exclusions and/or to request an exception from your employer:
Although requirements for insurance coverage for penile implants will vary from plan to plan, when your plan has coverage for penile surgery, they will typically have common steps. You will go through the process to get your procedure approved.
Required information may include:
This information may already be available as part of your medical records.
Penile implants may be deemed medically necessary to treat erectile dysfunction when other options fail. All penile implants manufactured by Boston Scientific are cleared for a stated indication to treat ED. Check with your insurer regarding coverage.
Contact your insurance by calling the number on the back of your insurance card. You need to determine if your health insurance covers penile implants for the treatment of ED. Specifically, ask if you have insurance coverage for a penile prosthesis or penile implant.
Work with an ED physician for treatment. If you have been referred to an ED physician by another, make sure the ED physician has access to your ED treatment records.
Your ED physician's office can help you understand your insurance coverage for the penile implant. They can obtain prior-authorization or pre-determination for the surgery. Note that prior-authorization or pre-determination is about coverage and medical necessity. It is not a guarantee an insurance plan will cover or pay for the costs.
Our Urology Procedure Access Program has helped remove employer exclusions related to erectile dysfunction with some employer-sponsored plans—helping working men gain access to medically necessary ED treatment.
Results from these cases are not necessarily predictive of results in other cases. Results in other cases may vary.
The cost of a penile implant procedure depends on several factors, including the type of implant, where the procedure is performed, your insurance coverage, and your individual medical circumstances.
Costs and coverage information vary and are subject to change. Please talk with your doctor or insurance provider for the most accurate and current cost estimate of a penile implant procedure.
For patients with health insurance, including Medicare, the total cost of a penile implant procedure is usually covered in part or in full by your plan. Your out-of-pocket costs will depend on your insurance plan’s co-pay, deductible, and co-insurance.
For patients without insurance coverage, or for patients whose insurance plans do not cover erectile dysfunction treatment with a penile implant, the total cost of the procedure can vary. In these cases, patients may be responsible for the full cost of the procedure, including the device and the surgery. Some providers may offer self-pay discounts or flat-rate surgical packages.
A percentage of the cost of covered services that a patient is responsible for after they have reached their deductible. This is a form of cost sharing between the insurance plan and the patient. For example, after the patient’s deductible has been met, the insurance plan will pay 80% of charges for covered services and the patient is responsible for the remaining 20%.
A fixed out-of-pocket amount paid by the patient when he receives services.
Current Procedural Terminology (CPT®) codes are part of the system used by doctors to describe the procedure performed or the services provided. Healthcare providers use CPT codes when submitting claims to health insurance plans.
A fixed out-of-pocket dollar amount the patient pays for covered services before co-insurance begins.
Describes whether the patient is active under the insurance plan and qualifies for health care benefits.
In-network refers to doctors or facilities that are part of an insurance plan’s group of providers that it has a contract with. Out-of-network simply means that the doctor or facility does not have a contract with the insurance plan. In general, services obtained by in-network providers and facilities result in lower patient out-of-pocket costs.
The health care program that assists low-income individuals in obtaining health care services. Medicaid is a joint program, funded primarily by the federal government and run at the state level, where coverage may vary.
Services that are reasonable, necessary, and/or appropriate for the treatment of an illness, injury, or disease condition.
An insurance plan’s set of guidelines for determining what and when medical services, procedures, devices, and drugs may be eligible for coverage.
The United States federal government health insurance program for individuals who are 65 years of age and older or for individuals who are disabled.
Amount the patient pays. This typically includes the self-pay, co-pay, deductible, and co-insurance.
A review by your insurer’s medical staff to conclude if the treatment qualifies for coverage. Additionally, PA or PD may determine if the treatment is a covered service and appropriate for your health care needs. These terms are often used interchangeably. They are both done before you get treatment.
A document provided to patients who have insurance. It details what benefits are included and excluded.
CPT® Copyright 2025 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.