Does J2320 require prior authorization?

No, J2320 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J2320?

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

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`J2320`, Injection, nandrolone decanoate, up to 50 mg

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation must show multiple symptoms of hypogonadism, including at least one 'more specific' symptom.
Documentation must include an established diagnosis of hypogonadism with androgen deficiency.

Psychotherapy is not required except when a mental health professional recommends it; such a psychotherapy recommendation must specify the goals of treatment and estimates of frequency and duration of therapy.

Key Coverage Criteria

Medically necessary gender reassignment surgery and related services only when the patient meets the criteria for gender dysphoria (see adult and adolescent criteria below).
Coverage includes biologic men on chronic steroid therapy who have low testosterone levels.
Coverage is allowed when there is an established diagnosis of hypogonadism with androgen deficiency that includes persistently low total testosterone levels and multiple symptoms of hypogonadism with at least one 'more specific' symptom.
Coverage includes biologic men with HIV who have low testosterone levels and weight loss.
Individual consideration for continued therapy may be given for men on continuous therapy ≥1 year when a morning total serum or free testosterone level tested within the last year remains below or within the lab's normal range.
Capacity to make a fully informed decision and to consent for treatment.

8 Active Policies

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

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

`J2320`, Injection, nandrolone decanoate, up to 50 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

J2320, Injection, nandrolone decanoate, up to 50 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`J2320`, Injection, nandrolone decanoate, up to 50 mg