Billing and Coding: Testopel Coverage

Medicare may cover Testopel (testosterone pellets) only for FDA‑approved indications when parenteral administration is justified (transdermal is the accepted standard and parenteral use should be rare), coverage limited to pellets actually implanted (maximum six) and wastage is not payable. Claims must state "Testopel" and the milligrams delivered in Item 19 (or Loop 2400/SV101‑7), report J3490 in Item 24D, and any additional pellets require documentation of medical necessity per the FDA label; compliance is subject to Recovery Auditor review.

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