Key facts for NCD 160.26
- Benefit category
- Diagnostic Tests (other)
- Effective date
- 08/24/2006
- Implemented 01/02/2007
- Transmittal
- Transmittal 61
- Versions published
- 1
- Manual chapter
- 160
- NCD Manual (Pub. 100-03)
TL;DR
NCD 160.26 sets Medicare's national policy for cavernous nerves by electrical stimulation with penile plethsmography under the benefit category "Diagnostic Tests (other)", effective 08/24/2006 and implemented 01/02/2007. Effective August 24, 2006, Cavernous Nerves Electrical Stimulation with penile plethysmography is non-covered under Medicare. CMS reviewed the evidence and determined that this test is not reasonable and necessary for Medicare beneficiaries undergoing… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
In nerve-sparing prostatic and colorectal surgical procedures, the assessment of the function of the cavernous nerves by direct application of electrical stimulation with penile plethysmography is a diagnostic test, also referred to as cavernosal nerve mapping, which may be performed to assess the integrity of the cavernous nerves. Through an open or laparoscopic procedure, the surgeon may want to assess the function of the cavernous nerves by stimulating the most distal end of the nerve that can be located by using an electrical nerve stimulator. The presence of a response and the degree of the response may be used to provide the surgeon with a more realistic assessment of the chance of the patient regaining potency and assist in choosing appropriate therapy.
Indications and limitations of coverage
B. Nationally Covered Indications
Not applicable.
C. Nationally Non-Covered Indications
Effective August 24, 2006, Cavernous Nerves Electrical Stimulation with penile plethysmography is non-covered under Medicare. CMS reviewed the evidence and determined that this test is not reasonable and necessary for Medicare beneficiaries undergoing nerve-sparing prostatic or colorectal surgical procedures.
D. Other
Also see §20.14, Plethysmograthy .
(This NCD last reviewed September 2006.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 160.26 version 1. View the original on cms.gov.
Revision history
11/2006 -Is not reasonable and necessary for Medicare beneficiaries undergoing nerve-sparing prostatic or colorectal surgical procedures. Effective date 8/24/2006. Implementation date 01/08/2007. ( TN 61 ) (CR 5294)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 160.26
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 160.26
What does NCD 160.26 cover?
Effective August 24, 2006, Cavernous Nerves Electrical Stimulation with penile plethysmography is non-covered under Medicare. CMS reviewed the evidence and determined that this test is not reasonable and necessary for Medicare beneficiaries undergoing nerve-sparing prostatic or colorectal surgical procedures. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 160.26 take effect?
The current version (1) is effective 08/24/2006, implemented 01/02/2007, published in transmittal 61. This is the only published version.
Does a Local Coverage Determination override NCD 160.26?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.