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In accordance with Chapter 645 of the Laws of 2005, the New York State (NYS) Medicaid program does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED). Additionally, Medicaid does not reimburse any supplies or procedures used to treat SD/ED for persons required to register as sex offenders.
Before providing services to Fidelis Care Medicaid members, providers must first obtain authorization for any prescription or physician-administered drugs and procedures or supplies related to SD or ED. Peyronie’s Disease (N48.6) is also classified as a SD diagnosis by the New York State Department of Health.
NYS Medicaid FFS has compiled the following list of services used for the treatment of SD/ED: (New York State Medicaid Update - September 2021 Volume 37 - Number 11)
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Members in our Medicaid Managed Care, HealthierLife (HARP), Fidelis Care at Home, and Wellcare Fidelis Dual Plus plans have access to a network of service providers to identify and address needs such as housing, food, transportation, and more.
Apply to our network and become a part of the Fidelis Care mission.
Access the Provider Attestation Statement and submit completion of training.
To submit prior authorization request types, use the Fidelis Care provider portal.
Submit claims electronically for faster processing and reimbursement.
Find information and links to external vendor authorizations and to internal resources.