A penile vacuum pump, also known as a Vacuum Erection Device (VED), is a non-invasive medical device used to manage erectile dysfunction (ED). The device works by using a cylinder placed over the penis and a pump mechanism to create negative pressure. This action draws blood into the corpora cavernosa to achieve a firm erection. A tension ring is then placed at the base of the penis to maintain the erection after the pump is removed.
Medicare Coverage Status
The direct answer is that Medicare currently does not cover the cost of a penile vacuum pump. While VEDs are classified as Durable Medical Equipment (DME) and would typically fall under Medicare Part B, Congress specifically excluded them from coverage. This exclusion was mandated by the Achieving a Better Life Experience (ABLE) Act of 2014, effective July 1, 2015. Claims submitted to Medicare for the VED and its related accessories (HCPCS codes L7900 and L7902) are automatically denied as “no benefit.” This statutory exclusion means that neither Original Medicare (Part A and Part B) nor Medicare Advantage (Part C) plans are permitted to pay for the device.
Requirements for Medical Necessity
Historically, before the statutory exclusion, Medicare covered VEDs when strict medical necessity criteria were met. Coverage was limited to men with a documented, organic cause for their erectile dysfunction, such as diabetes, cardiovascular disease, or erectile issues following prostate cancer treatment. A physician, typically a Urologist, was required to document the underlying medical condition and confirm the VED was a necessary treatment component. This documentation had to establish that the erectile dysfunction was not psychogenic in nature. However, due to the current statutory non-coverage, meeting these detailed medical necessity requirements no longer results in Medicare payment for the vacuum pump itself.
Beneficiary Financial Responsibility
Since the penile vacuum pump is designated as a statutorily non-covered item, the beneficiary is responsible for 100% of the purchase price. There is no Medicare-approved amount for the device, and therefore no deductible or coinsurance is applied. This contrasts with covered Durable Medical Equipment (DME), where Medicare pays 80% of the cost after the beneficiary meets the Part B deductible. Because the VED is non-covered, the beneficiary must pay the full cost directly to the supplier. The entire cost is out-of-pocket regardless of the supplier’s Medicare status.
Steps to Obtain the Device
Even though Medicare will not pay for the device, a man still needs to consult with a healthcare provider to obtain a prescription for a penile vacuum pump. Since the VED is a medical product, a prescription ensures it is appropriate for the patient’s specific health profile. The physician should still document the medical need for the patient’s records, even if it is not for Medicare reimbursement. The next step involves finding a medical supply company or pharmacy that sells VEDs directly to consumers, as the transaction is handled as a private purchase. If a claim is submitted to Medicare, it will result in an official denial notice confirming the statutory exclusion, and appeals for such items are generally unsuccessful.