CMS NCD 314: Cavernous Nerves Electrical Stimulation — What Billing Teams Need to Know in 2026
The Centers for Medicare & Medicaid Services (CMS) has issued a modified policy update to NCD 314, covering cavernous nerves electrical stimulation with penile plethysmography (also called cavernosal nerve mapping). This policy, effective March 12, 2026, reaffirms and updates the long-standing non-coverage determination that CMS originally established in August 2006. If your practice or facility performs nerve-sparing prostate or colorectal surgeries and bills Medicare, this policy directly affects your claim submission strategy.
| 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 | 2026-03-12 |
| Impact Level | Medium — longstanding non-coverage reaffirmed; risk is in inadvertent claim submission |
| Specialties Affected | Urology, colorectal surgery, general surgery, intraoperative neurophysiology |
| Key Action | Ensure cavernosal nerve mapping is excluded from Medicare claims for nerve-sparing prostate and colorectal procedures and that patients receive appropriate ABN documentation if this service is offered. |
What Is Cavernosal Nerve Mapping and Why CMS Won't Cover It
Cavernous nerves electrical stimulation with penile plethysmography — commonly referred to as cavernosal nerve mapping — is a diagnostic technique performed intraoperatively during nerve-sparing prostatic or colorectal surgery. The goal is straightforward: the surgeon applies an electrical nerve stimulator to the most distal accessible portion of the cavernous nerves, and the corresponding penile response is measured via plethysmography.
The presence and degree of response are intended to give the surgeon a more realistic picture of whether the patient is likely to regain potency following surgery, and to help guide post-operative therapy decisions. On its face, this sounds clinically useful — and in some surgical settings, it may be. But CMS has a different view for Medicare beneficiaries.
Following a formal evidence review completed in September 2006, CMS determined that cavernous nerves electrical stimulation with penile plethysmography is not reasonable and necessary for Medicare beneficiaries undergoing nerve-sparing prostatic or colorectal procedures. That determination is codified under NCD 314 and carries the force of a National Coverage Determination, meaning it applies uniformly across all Medicare Administrative Contractors (MACs) — there is no local override available.
CMS Coverage Status Under NCD 314: Non-Covered, No Exceptions
This is not a nuanced coverage policy with carve-outs for specific diagnoses or patient populations. NCD 314 is categorical.
Nationally Covered Indications: Not applicable. CMS has designated no covered indications for this service.
Nationally Non-Covered Indications: Effective August 24, 2006, cavernous nerves electrical stimulation with penile plethysmography is non-covered under Medicare — for all patients, in all settings, regardless of the specific nerve-sparing procedure being performed.
The NCD applies to both open and laparoscopic surgical approaches. Whether the underlying procedure is a radical prostatectomy, a rectal resection, or another nerve-sparing colorectal surgery, the cavernosal nerve mapping component carries no Medicare reimbursement pathway.
The 2026 modification to this policy does not change the fundamental coverage determination. Rather, it represents a formal administrative update to the NCD record. Billing teams should treat the coverage status as unchanged — non-covered — while ensuring internal documentation and claim edits reflect the current policy version.
How NCD 314 Intersects with Plethysmography Billing More Broadly
CMS cross-references NCD 314 with §20.14, Plethysmography, which governs broader coverage rules for plethysmography services under Medicare. Billing teams handling any plethysmography claims — not just cavernosal nerve mapping — should review §20.14 to ensure full compliance across that service category.
The distinction matters because plethysmography itself has legitimate covered applications in other clinical contexts (venous studies, for example). The non-coverage under NCD 314 is specific to the combination of cavernous nerve electrical stimulation with penile plethysmography in the context of nerve-sparing prostatic or colorectal surgery. Conflating these two policy areas in your claim edits or billing protocols would be an error in either direction.
| 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 |
Affected Codes
The policy data for NCD 314 as published does not list specific CPT or HCPCS codes. There are no covered codes, no investigational/experimental codes, and no associated ICD-10-CM codes enumerated in the current policy document.
This absence of specific codes is itself important billing guidance. It means:
- There is no CMS-recognized billing code pathway for this service under Medicare.
- Claims submitted for cavernosal nerve mapping in the context of nerve-sparing surgery will not find a covered code to attach to — they should not be submitted to Medicare for reimbursement.
- If your practice has historically used unlisted procedure codes or appended cavernosal nerve mapping to surgical claims, those submissions are non-compliant with NCD 314.
Consult your MAC's local coverage resources or coding guidelines if you need guidance on how a specific claim line should be handled in the context of a broader surgical procedure.
What Your Billing Team Should Do
| # | Action Item |
|---|---|
| 1 | Audit active claim templates and charge capture workflows immediately. Review any surgical case types involving nerve-sparing prostatectomy or colorectal resection to confirm cavernosal nerve mapping is not being captured as a billable line item on Medicare claims. This audit should be completed before the March 12, 2026 effective date. |
| 2 | Update your claim editing rules to flag or suppress any submission of cavernosal nerve mapping services to Medicare. Since no specific CPT or HCPCS code is enumerated in NCD 314, work with your coding team to identify any unlisted or miscellaneous codes your facility may have used for this service and add them to your Medicare claim scrubber exclusions. |
| 3 | Implement Advance Beneficiary Notice (ABN) protocols for patients who request this service. If a surgeon or patient wants cavernosal nerve mapping performed despite the non-coverage determination, an ABN (CMS Form CMS-R-131) must be issued prior to the service so the patient understands they will be financially responsible. Failure to issue an ABN means you cannot bill the patient for the non-covered service. |
| 4 | Brief your urology and colorectal surgery teams on the current NCD status. Surgeons may not be aware of the Medicare non-coverage determination, particularly newer providers or those joining your group from non-Medicare-heavy practices. A brief policy memo distributed before the effective date reduces the risk of inadvertent claim submission. |
| 5 | Cross-check your §20.14 Plethysmography billing protocols. Since NCD 314 cross-references the plethysmography NCD, use this policy update as an opportunity to confirm your broader plethysmography claim practices are fully compliant. |
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