Does J1071 require prior authorization?

Yes, J1071 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J1071?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J1071`, Injection, testosterone cypionate, 1 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

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.

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.
Injectable testosterone and Testopel (testosterone pellets) are proven for replacement therapy in conditions associated with a deficiency or absence of endogenous testosterone, including primary hypogonadism (congenital or acquired) and hypogonadotropic hypogonadism (congenital or acquired).
Injectable testosterone and Testopel (testosterone pellets) are medically necessary for replacement therapy in conditions associated with a deficiency or absence of endogenous testosterone, including primary hypogonadism (congenital or acquired) and hypogonadotropic hypogonadism (congenital or acquired), when the following criteria are met (see policy for detailed criteria).
Replacement therapy following bilateral orchiectomy.
Replacement therapy for patients with panhypopituitarism.

20 Active Policies

NORIDIAN-JE-L36538, Treatment of Males with Low Testosterone

NORIDIAN-JF-L36538, Treatment of Males with Low Testosterone

PALMETTO-JJ-L39086, Treatment of Males with Low Testosterone

PALMETTO-JM-L39086, Treatment of Males with Low Testosterone

BCBSNJ-DRUGS-090-9FA123334C, Testosterone [Implantable Testosterone Pellets (Testopel Pellets), Testosterone Undecanoate (Aveed)], Testosterone Cypionate (Depo-Testosterone), or Testosterone Enanthate (Delatestryl)]

AETNA-CPB-0457, Dry Eyes

BCBSIL-SUR717.001, Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

BCBSIL-RX501.076, Testosterone Replacement Therapies

BCBSMT-SUR717.001, Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

BCBSMT-RX501.076, Testosterone Replacement Therapies

BCBSNM-SUR717.001, Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

BCBSNM-RX501.076, Testosterone Replacement Therapies

BCBSOK-RX501.076, Testosterone Replacement Therapies

UMR-POL-UMR-testosterone-replacement-supp-therapy, Testosterone Replacement or Supplementation Therapy

SUREST-POL-SUREST-testosterone-replacement-supp-therapy, Testosterone Replacement or Supplementation Therapy

BCBSOK-SUR717.001, Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

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

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

UHC-POL-testosterone-replacement-supp-therapy, Testosterone Replacement or Supplementation Therapy

AETNA-CPB-0788, Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments

`J1071`, Injection, testosterone cypionate, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1071, Injection, testosterone cypionate, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1071`, Injection, testosterone cypionate, 1 mg