Billing and Coding: Treatment of Males with Low Testosterone

Medicare may cover injectable testosterone pellets (Testopel) for males when used for an FDA‑approved indication and when all Medicare coverage requirements (MBPM Ch.15 §50.4.3) are met, with documentation of medical necessity. Typical dosing is 150–450 mg (about 2–6 pellets) every 3–6 months, but insertion of more than 6 pellets per 3 months is not considered reasonable and necessary and medication wastage is not covered; claims must include a valid ICD‑10 code and required ordering/referring physician information.

"Medicare may cover injectable testosterone pellets (Testopel) for males when used for an FDA‑approved indication and when the service meets Medicare coverage requirements in CMS Medicare Benefit Po..."

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