Billing and Coding: Testopel Coverage

Medicare may cover Testopel (injectable testosterone pellets) only for FDA‑approved indications when all Medicare coverage rules in MBPM Chapter 15 §50.4.3.2 are met; injectable use should be rare because transdermal therapy is the accepted standard. Claims must document 'Testopel' and the milligrams delivered in Item 19 (or electronic equivalent) and bill with J3490 in Item 24D; Medicare covers only pellets actually implanted (maximum six) and wastage is not covered, with additional pellets considered only on appeal with supporting documentation.

"Injectable testosterone pellets (Testopel) are covered when used for the FDA‑approved indication and all Medicare coverage requirements in MBPM Chapter 15, Section 50."

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