54417 prior authorization | Blue Cross and Blue Shield of Montana

54417, Removal and replacement of non- inflatable (semi-rigid) or inflatable (self- contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 54417
Description: Removal and replacement of non- inflatable (semi-rigid) or inflatable (self- contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 47 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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