Does Insurance Cover Penile Implant Surgery?

Penile implant surgery is considered a third-line treatment option for erectile dysfunction (ED) when other treatments have failed or are unsuitable for the patient¹. The 2025 EAU Guidelines recognize penile prosthesis implantation as having one of the highest satisfaction rates (92-100% in patients and 91-95% in partners) among all ED treatment options². According to the EAU Guidelines, penile implants are recommended for patients who: 1) are not suitable for different pharmacotherapies or prefer a definitive therapy, and 2) do not respond to other treatment modalities³. There are two main types of penile implants available: inflatable devices (two-piece and three-piece) and semi-rigid devices (malleable, mechanical, and soft flexible)⁴. The three-piece inflatable devices are often preferred by patients due to the more natural erections obtained, while semi-rigid prostheses may be recommended for patients with limited manual dexterity⁵. Insurance coverage for penile implant surgery is typically available when medical necessity can be demonstrated⁶. This usually requires documentation that the patient has organic erectile dysfunction that has not responded to less invasive treatments such as oral medications (PDE5 inhibitors), vacuum erection devices, or intracavernosal injections⁷. Most insurance providers, including Medicare in the United States, consider penile implants medically necessary when these criteria are met⁸. The pre-authorization process typically requires detailed documentation from your urologist, including a comprehensive medical history, physical examination findings, and records of previous ED treatments attempted⁹. Patients with certain medical conditions, such as diabetes mellitus, should be aware that they may have higher risk factors for complications such as prosthesis infection, which could affect both insurance approval and surgical outcomes¹⁰. It’s important to note that while the EAU Guidelines provide strong recommendations for penile prosthesis implantation in appropriate patients, they do not specifically address insurance coverage variations across different healthcare systems¹¹. Patients should work closely with their healthcare providers and insurance companies to determine specific coverage details, including potential out-of-pocket costs, deductibles, and copayments that may apply¹². For optimal results and to minimize complications, the EAU Guidelines recommend that penile implant surgery be performed at high-volume centers with experienced surgeons, which may also be a factor in insurance authorization¹³. The guidelines report infection rates of 2-3% with primary implantation in low-risk patients at high-volume centers, which may be further reduced to 1-2% by using antibiotic-impregnated or hydrophilic-coated prostheses¹⁴.