S0090 Sildenafil citrate, 25 mgSildenafil citrate, 25 mg
Status I: not valid for Medicare (Medicare uses another code).
0 of 1 payer prior-auth lists that name S0090 require prior authorization or set conditions.
S0090 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Benign Prostatic Hyperplasia (0079) | not covered | Apr 15, 2026 | payer document |
| Aetna | Erectile Dysfunction and Peyronie's Disease (0007) | not covered | Jul 29, 2026 | payer document |
| Aetna | Infertility (0327) Vasodilators for women undergoing fertility treatment | not covered | Jul 16, 2026 | payer document |
| Aetna | Multiple Sclerosis (0264) Serum neurofilament, Osteopontin, Clemastine fumarate, Intravesical vanilloids, cannabis and cannabinoids | not covered | Sep 10, 2026 | payer document |
| Aetna | Pulmonary Hypertension Treatments and Selected Indications of Prostanoids (0184) | covered if criteria are met | Sep 2, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Pulmonary Arterial Hypertension (L.5.01.465) | covered if criteria are met | payer document | |
| BlueCross BlueShield of South Carolina | Advanced Therapies for Pharmacologic Treatment of Pulmonary Hypertension (CAM 50109) | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in IN.
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.