J2320, Injection, nandrolone decanoate, up to 50 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Documentation must show multiple symptoms of hypogonadism, including at least one 'more specific' symptom.
- Documentation must include an established diagnosis of hypogonadism with androgen deficiency.
- Documentation must include persistently low total testosterone levels.
- Psychotherapy is not required except when a mental health professional recommends it; such a psychotherapy recommendation must specify the goals of treatment and estimates of frequency and duration of therapy.
Key Coverage Criteria
- Medically necessary gender reassignment surgery and related services only when the patient meets the criteria for gender dysphoria (see adult and adolescent criteria below).
- Coverage includes biologic men on chronic steroid therapy who have low testosterone levels.
- Coverage is allowed when there is an established diagnosis of hypogonadism with androgen deficiency that includes persistently low total testosterone levels and multiple symptoms of hypogonadism with at least one 'more specific' symptom.
- Coverage includes biologic men with HIV who have low testosterone levels and weight loss.
- Individual consideration for continued therapy may be given for men on continuous therapy ≥1 year when a morning total serum or free testosterone level tested within the last year remains below or within the lab's normal range.
- Capacity to make a fully informed decision and to consent for treatment.
8 Active Policies
BCBSIL-SUR717.001, Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
BCBSIL-RX501.076, Testosterone Replacement Therapies
BCBSMT-SUR717.001, Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
BCBSMT-RX501.076, Testosterone Replacement Therapies
BCBSNM-SUR717.001, Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.