Implantable Hormone Pellets

Aetna covers implantable testosterone pellets for delayed male puberty, gender dysphoria (requires diagnosis, informed decision, controlled comorbidities, counseling on risks and fertility preservation, specialist prescribing/mental health collaboration for <18 and Tanner ≥2), and primary or hypogonadotropic hypogonadism—requiring at least two confirmed low morning testosterone levels before initiation and a prior confirmed low level for continuation. Implantable estradiol pellets and progestin/progesterone pellets for dysmenorrhea/erythema nodosum are investigational, testosterone pellets are investigational for age-related/idiopathic hypogonadism, male menopause, cancer treatment, pain management or menopausal symptoms, several related ICD‑10 indications are excluded, and CPT 11981 is not covered for progestin/progesterone pellet insertion.

"Covered ICD-10 diagnoses if selection criteria are met: E23."