TL;DR: The Centers for Medicare & Medicaid Services modified NCD 314 covering cavernous nerves electrical stimulation with penile plethysmography, effective January 9, 2026. This procedure remains non-covered under Medicare. Billing teams should flag any claims for this service and redirect surgical teams accordingly.
CMS cavernous nerves electrical stimulation coverage policy under NCD 314 in the CMS Medicare system has been reviewed and updated as of January 9, 2026. The procedure — also called cavernosal nerve mapping — involves direct electrical stimulation of cavernous nerves combined with penile plethysmography during nerve-sparing prostatic or colorectal surgery. No CPT or HCPCS codes are listed in this policy. The non-coverage determination remains in effect, and claims submitted for this service will be denied.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Cavernous Nerves by Electrical Stimulation with Penile Plethysmography |
| Policy Code | NCD 314 |
| Change Type | Modified |
| Effective Date | January 9, 2026 |
| Impact Level | Low — policy confirms long-standing non-coverage; no new exposure |
| Specialties Affected | Urology, colorectal surgery, general surgery, oncology |
| Key Action | Do not bill Medicare for cavernous nerve mapping; flag any charge capture entries for this service and remove them before claim submission |
CMS Cavernous Nerves Electrical Stimulation Coverage Criteria and Medical Necessity Requirements 2026
This is not a new restriction. The Centers for Medicare & Medicaid Services determined that cavernous nerves electrical stimulation with penile plethysmography does not meet the Medicare medical necessity standard. That determination took effect August 24, 2006. The January 9, 2026 update is a policy review — not a coverage change.
The procedure in question is a diagnostic test performed during nerve-sparing prostatectomies or colorectal surgeries. The surgeon uses an electrical nerve stimulator on the most distal end of the cavernous nerve to assess nerve integrity. The response — or lack of one — theoretically helps predict whether the patient will regain erectile function after surgery.
CMS reviewed the clinical evidence and found the test is not reasonable and necessary for Medicare beneficiaries in these surgical settings. That language — "not reasonable and necessary" — is the standard medical necessity threshold under Medicare. It means the service does not qualify for reimbursement under any Medicare benefit category, regardless of how it's coded or documented.
There are no prior authorization requirements to know about here. You cannot satisfy a prior authorization requirement for a service that Medicare won't cover at all. The non-coverage is absolute under this national coverage determination.
If your surgical teams have been documenting this procedure and your billing team has been omitting it from claims, that's the right approach. Keep doing that. If anyone in your practice is unclear on why this service doesn't appear on your charge master, point them to NCD 314 and the August 2006 effective date.
CMS Cavernous Nerves Electrical Stimulation Exclusions and Non-Covered Indications
The coverage policy under NCD 314 is straightforward: there are no nationally covered indications. None. CMS lists zero covered uses for cavernous nerves electrical stimulation with penile plethysmography in the Medicare program.
The sole indication evaluated — assessment of cavernous nerve function during nerve-sparing prostatic or colorectal surgical procedures — is explicitly non-covered. CMS concluded the evidence did not support medical necessity for Medicare beneficiaries undergoing these procedures. That conclusion has held through two policy reviews.
This is a national coverage determination, which means no Medicare Administrative Contractor can override it with a local coverage determination. A MAC cannot create an LCD that covers something an NCD explicitly excludes. If a provider in your practice believes their MAC will reimburse this service, they're wrong. The NCD takes precedence.
The cross-reference in this policy points to NCD 20.14 for plethysmography broadly. If your billing team handles plethysmography claims in other clinical contexts, review NCD 20.14 separately. The non-coverage in NCD 314 is specific to the cavernous nerve application — don't let this policy create confusion about plethysmography reimbursement in other settings.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Cavernous nerve assessment during nerve-sparing prostatectomy | Not Covered | Not listed in policy | Non-coverage effective August 24, 2006; confirmed January 9, 2026 |
| Cavernous nerve assessment during nerve-sparing colorectal surgery | Not Covered | Not listed in policy | Same NCD 314 non-coverage determination applies |
| Penile plethysmography combined with electrical nerve stimulation (intraoperative) | Not Covered | Not listed in policy | See also NCD 20.14 for plethysmography in other contexts |
CMS Cavernous Nerves Electrical Stimulation Billing Guidelines and Action Items 2026
The January 9, 2026 policy update does not change what you should do. It confirms what you should already be doing. But a policy review is a good trigger to audit your practices and make sure nothing has drifted.
| # | Action Item |
|---|---|
| 1 | Audit your charge master and charge capture templates now. Search for any line items related to cavernous nerve stimulation, cavernosal nerve mapping, or intraoperative electrical nerve stimulation with plethysmography. Remove them from any Medicare charge capture workflow before they generate a claim. |
| 2 | Educate your surgical and coding teams. Urologists and colorectal surgeons performing nerve-sparing procedures may document this technique in their operative notes. Make sure your coders know this documentation does not create a billable charge under Medicare — even if the surgeon considers it clinically valuable. |
| 3 | Review any denied claims for this service going back 12 months. If you have a claim denial for a plethysmography-related service, confirm whether it relates to NCD 314 or another policy. NCD 20.14 governs plethysmography more broadly, and the reason codes on your remittance advice should tell you which determination triggered the denial. |
| 4 | Do not attempt to bill this service under an alternative code. The policy does not list specific CPT or HCPCS codes. That does not mean you can find a code that "fits" and submit it. The non-coverage applies to the procedure regardless of how it's coded. Billing for a non-covered service under a different code creates false claims exposure. If you're unsure how your coding team is handling related intraoperative procedures, loop in your compliance officer before the next surgical case hits your billing queue. |
| 5 | Check your ABN workflow. An Advance Beneficiary Notice of Noncoverage can allow a patient to choose to pay out of pocket for a non-covered service. If your surgeons believe cavernosal nerve mapping has clinical value and want to offer it to patients, an ABN is the mechanism. But your billing team needs to confirm the ABN is properly executed, signed, and documented before the service — not after. An ABN obtained retroactively offers no protection. |
| 6 | Cross-reference NCD 20.14 if you bill plethysmography in other clinical contexts. The policy cross-reference is not decorative. If your practice bills penile plethysmography for erectile dysfunction evaluation or vascular studies outside of the nerve-sparing surgical context, confirm those claims fall under NCD 20.14 and not NCD 314. The billing guidelines for each NCD are separate. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Cavernous Nerves Electrical Stimulation Under NCD 314
No Codes Listed in Policy
The CMS cavernous nerves electrical stimulation coverage policy under NCD 314 does not list specific CPT or HCPCS codes. This is not unusual for NCDs established before the current code sets were standardized.
The absence of listed codes does not mean the procedure is billable. It means the non-coverage applies to the procedure itself — and any code used to describe that procedure would be subject to the same determination.
| Field | Detail |
|---|---|
| CPT Codes | None listed in NCD 314 |
| HCPCS Codes | None listed in NCD 314 |
| ICD-10-CM Codes | None listed in NCD 314 |
| Related Policy | NCD 20.14 — Plethysmography (see CMS coverage database) |
If your billing team needs to locate codes historically associated with intraoperative nerve stimulation or penile plethysmography for internal audit purposes, pull that list from your EHR or encoder — then cross-check each one against the NCD 314 procedure description. The question to ask is: does this code describe the assessment of cavernous nerve function by electrical stimulation with penile plethysmography during a nerve-sparing procedure? If yes, it's non-covered under Medicare.
What This Policy Review Actually Tells You
Here's the honest read on this update: a 2006 non-coverage determination reviewed in September 2006 and again in January 2026 tells you CMS has looked at this twice in 20 years and reached the same conclusion both times. The evidence for cavernosal nerve mapping has not moved the needle.
That matters for a few reasons. First, if anyone on your team has been waiting for CMS to reconsider this coverage policy, this review is the answer. Second, if your practice has adopted intraoperative nerve monitoring technology more broadly, confirm your coding team is drawing the right line between covered nerve monitoring services and this specific non-covered application.
Third — and this is the practical issue for cavernous nerve mapping billing — the lack of assigned codes makes this procedure invisible in most claim scrubbers and charge capture systems. A service with no assigned code generates no automatic edit. That means the safeguard has to be human: your surgical coders need to recognize this procedure in an operative note and know it doesn't belong on a Medicare claim.
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