Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

Hypogonadism is a clinical syndrome resulting from a failure of the testis to produce physiological levels of testosterone and/or a normal number of spermatozoa. Testosterone testing is used to measure serum testosterone levels.

Conditions of Coverage:

• Suspected or known primary hypogonadism
• Suspected or known secondary hypogonadism with organic cause, e.g.: Pituitary disorders
  • Suprasellar tumor
  • Medications suspected to cause hypogonadism
  • HIV with weight loss
  • Osteoporosis
• Physical signs of hypogonadism
  • Symptoms of sexual dysfunction (all three criteria from European Male Aging Study) Poor morning erection;
  • Low sexual desire; and
  • Erectile dysfunction
• Monitoring of testosterone therapy

This decision does not apply to females, males under age 18, or transgender persons.

Implementation of the Coverage Decision

All requests for testosterone testing require prior authorization. The testing may be used only for care of a condition accepted on the claim.