During the 2014 winter session of congress legislatures enacted a bill titled the ABLE Act. The bill passed the United States Senate as a bipartisan law to create tax free savings accounts for individuals with disabilities. To offset the legislation’s cost Medicare eliminated, among other spending cuts, reimbursement for vacuum erection devices as a covered treatment for erectile dysfunction.
While Medicare will officially discontinue coverage for the VED on July 1, 2015, and as a double-negative for Medicare beneficiaries who “would” have qualified for reimbursement, coverage was practically eliminated for most Medicare beneficiaries in August of 2014. Many men who would have qualified for coverage in July of 2014 were unlikely to qualify for Medicare coverage by September of 2014.
Medicare and Medicaid Services (CMS) adopted a new Local Coverage Determination (LCD) policy in August of 2014 that effectively reduced the number of men who seek and qualify for Medicare coverage by potentially as much as 60%.
The August 2014 Local Coverage Determination (LCD) created requirements that mandate extensive medical documentation of prior treatment courses for ED, ask doctors to rule out hypogonadism as a cause of ED, require a genital examination and digital rectal exam, and impose upon physicians to create detailed written notes. This requirement goes beyond simple medical necessity statements and the more traditional use of diagnosis coding. The August 2014 LCD for vacuum erection device coverage created a new standard for treatment described by many physicians as extreme.
For those select male Medicare beneficiaries who meet the very specific requirements of the August 2014 LCD, Medicare coverage for a vacuum erection device is available but the clock is ticking………. .