NEW YORK STATE SEXUAL and ERECTILE DYSFUNCTION GUIDELINES: Medicaid Managed Care, Partnership in Care (PIC) HIV-SNP, Enhanced (HARP) Plan

NYS requirements for Sexual Dysfunction (SD) and Erectile Dysfunction (ED):

• In accordance with Chapter 645 of the Laws of 2005, NYS Medicaid does not pay for Sexual Dysfunction (SD) or Erectile Dysfunction (ED) related drugs, this includes prescriptions or physician administered drugs.
• NYS Medicaid will not pay for medical supplies and procedures related to SE/ED for registered sex offenders.
• Preservice review requirement: NYS requires that all requests for SD/ED services (procedures and medical supplies) must undergo verification through the NYS department of health Erectile Dysfunction Verification System (EDVS) before services are rendered. This requirement for preservice verification includes requests for any drugs that may be used for SD/ED services (including FDA labeled and off-label indications). Therefore, ALL requests for the billing codes listed below require prior authorization.

Read More