decisionhealth Newsletters, Answer Books - 2007 Issue 1 (January)
Appendix E - National Coverage Determinations Manual / NCD 160.26
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Article Overview
This page presents the CMS National Coverage Determinations Manual entry for NCD 160.26 and explains the Medicare coverage status of cavernous nerve electrical stimulation with penile plethysmography. It is relevant to coders, billers, compliance staff, and clinicians who need to understand the policy’s effective date, the clinical setting it applies to, and the fact that the service is nationally non-covered under Medicare. The article also notes a related manual reference for plethysmography.
Why This Topic Matters
Coverage determinations directly affect whether a service is payable under Medicare and whether claims may require special handling or denial prevention review. Understanding this policy helps organizations align documentation, billing workflows, and compliance review with CMS guidance.
Article Sections
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A. General
Introduces the clinical context for the diagnostic test and describes the general purpose of assessing cavernous nerve function in surgical settings.
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B. Nationally Covered Indications
States the coverage status for nationally covered indications in this NCD section.
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C. Nationally Non-Covered Indications
States the Medicare non-coverage determination and the effective date for this policy.
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D. Other
Provides a cross-reference to a related manual topic and includes the review date for the NCD.
What You Will Learn
- The overall Medicare coverage status for the topic addressed in the NCD
- The clinical setting and general purpose of the diagnostic test described in the policy
- The effective date and review timing associated with the determination
- Where the article points readers for related manual information
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Health information management staff
- Clinicians involved in documentation or procedure selection
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