This policy only addresses coverage of testosterone in adult individuals (age 18 years and older). Testosterone is a naturally occurring lipophilic androgen ... |
8 авг. 2024 г. · A. Coverage of the requested drug is provided when all the following are met: a. FDA approved age b. Diagnosis of male hypogonadism. |
See CPT/HCPCS Code section below. Coverage: Hormone Pellet Implantation for Hormone Therapy (e.g., testosterone pellets) are covered in policy 2009047. |
AndroGel ® (testosterone gel) ST Requires prior use of ONE step 1 medication OR history of prior use of any step 2 medication within the previous 130 days. |
7. Testing for serum total testosterone (See Note 1) may be reimbursable in men receiving testosterone replacement therapy every 3-6 months for the first year ... |
For initial therapy, testosterone will be approved for patients with at least two confirmed low morning testosterone levels according to current practice ... |
3 июл. 2023 г. · Member has a total testosterone level ≤ 350 ng/dL within the past three months (documentation is required): • Has the member had a previous ... |
October 2023: Criteria update: Addition of notation to policy “Coverage may vary by state. Check applicable state laws for more information.” Page 6. BLUE CROSS ... |
Newly marketed drugs may not be covered until the committee has had an opportunity to evaluate based on these criteria. How member payment is determined. |
3 авг. 2020 г. · Blue Cross and Blue Shield of Louisiana is an independent licensee ... Testim®‡ (testosterone gel) may be considered eligible for coverage** when ... |
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