`L7902` Tension ring, vac erect dev

Tension ring, for vacuum erection device, any type, replacement only, each

Medicare coverage: Non-covered by statute
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Payer policies and prior authorization for L7902

1 of 1 payer prior-auth lists that name L7902 require prior authorization or set conditions: UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026

Payer coverage policies that name L7902

L7902 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Erectile Dysfunction and Peyronie's Disease (0007)	covered if criteria are met	Jul 29, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, OH.

VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

L7902 Tension ring, vac erect dev

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for L7902

Payer coverage policies that name L7902

Medicaid fee-for-service

`L7902` Tension ring, vac erect dev