Testosterone laboratory testing reimbursement
Defines BCBSNM reimbursement criteria for laboratory measurement of testosterone and related hormones, and governs provider billing and documentation for covered members under BCBSNM plans.
No material clinical or coverage changes in this revision.
Testosterone Testing Coverage Criteria
Testosterone testing coverage criteria
Covered when ALL of the following nested conditions are met, or specifically excluded as noted:
ALL of the following
Initial screening
- Two measurements at least 24 hours apart for symptoms of androgen deficiency or androgen excess in males
- If initial screening was normal but symptoms persist, follow-up testing allowed no sooner than 60 days after the initial screening
Monitoring and follow-up
- For men receiving testosterone replacement therapy: monitoring every 2-3 months for the first year after initiation or after a change in therapeutic dosage; annually thereafter
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.