Skip to main content

ICD-10-CM E29.8, Other testicular dysfunction | No Prior Auth

Backwork Sign up free

Ask Backwork/E29.8

`E29.8`, Other testicular dysfunction

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding guidance must be used in conjunction with the associated Local Coverage Determination (LCD).
The patient's medical record must document medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
A claim submitted without a valid ICD‑10‑CM diagnosis code that best describes the condition will be returned as an incomplete claim under §1833(e) of the Social Security Act.

Key Coverage Criteria

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 Policy Manual, Chapter 15, §50.4.3.
Injectable testosterone pellet therapy may be used when alternative accepted routes (transdermal, oral, nasal, intramuscular) are clinically inappropriate or insufficient and medical necessity is documented.

2 Active Policies

A57615, Billing and Coding: Treatment of Males with Low Testosterone

A58828, Billing and Coding: Treatment of Males with Low Testosterone

Related Codes

11980(2 policies)84410(2 policies)96372(2 policies)D35.2(2 policies)D44.3(2 policies)E23.0(2 policies)E23.1(2 policies)E23.3(2 policies)

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about E29.8 Sign up free

For diagnostic tests, report the test result if known on the claim; if result is not known, report the symptoms that prompted the test.

Medical record documentation supporting services within the related LCD must be available to Medicare upon request.