Testosterone – G2013
Defines coverage criteria and limitations for measurement of serum total, free, bioavailable testosterone and related tests (SHBG, albumin, estradiol, dihydrotestosterone) for diagnosis and monitoring across indications including male hypogonadism, prostate cancer monitoring, gender-affirming care, gynecomastia, androgen excess in females, and congenital disorders.
No material clinical or coverage changes — policy content remains unchanged.
Coverage Summary
This policy provides coverage criteria for laboratory measurement of serum testosterone and related tests with a mixed coverage stance: some indications and follow-up/monitoring scenarios MEET COVERAGE CRITERIA while other uses DO NOT. Key covered populations and indications include: males with suspected hypogonadism or androgen excess, monitoring men on prostate cancer enzyme inhibitors, men receiving testosterone replacement therapy, gender-dysphoric/gender-incongruent persons for baseline and monitoring, symptomatic females evaluated for androgen excess (e.g., PCOS), evaluation of gynecomastia, and diagnosis/assessment of certain congenital disorders (e.g., 5-alpha reductase deficiency). The policy recommends using assays certified by the CDC HoSt/Testosterone program when available.
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