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Coverage Summary - UHCprovider.com Home

Page 1 of 3 UHC MA Coverage Summary : Impotence Treatment Proprietary Information of UnitedHealthcare Copyright 2020 United HealthCare Services, Inc. Coverage Summary Impotence Treatment Policy Number: I-004 Products: UnitedHealthcare Medicare Advantage Plans Original Approval Date: 07/16/2008 Approved by: UnitedHealthcare Medicare Benefit Interpretation Committee Last Review Date: 08/18/2020 Related Medicare Advantage Policy Guidelines: Cavernous Nerves by Electrical Stimulation with Penile Plethysmography (NCD ) Diagnosis and Treatment of Impotence (NCD ) Testosterone Pellets (Testopel ) This information is being distributed to you for personal reference. The information belongs to UnitedHealthcare and unauthorized copying, use, and distribution are prohibited. This information is intended to serve only as a general reference resource and is not intended to address every aspect of a clinical situation.

The benefit information in this Coverage Summary is based on existing national coverage ... Also see the Medicare Prescription Drug Benefit Manual,Chapter 6, ...

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