UnitedHealthcare · PayerPolicy · UHC-POL-testosterone-replacement-supp-therapy
Summary of the payer’s published policy. Not a coverage determination — confirm with UnitedHealthcare before submitting.
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Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
| Code | Code system | Status in this policy |
|---|---|---|
| 11980 | CPT | Covered |
| J1071 | HCPCS | Covered |
| J1072 | HCPCS | Covered |
| J1073 | HCPCS | Covered |
| J3121 | HCPCS | Covered |
| J3145 | HCPCS | Covered |
| E23.0 | ICD10CM | Covered |
| E23.3 | ICD10CM | Covered |
| E29.1 | ICD10CM | Covered |
| E30.0 | ICD10CM | Covered |
| E89.3 | ICD10CM | Covered |
| E89.5 | ICD10CM | Covered |
| F64.0 | ICD10CM | Covered |
| F64.1 | ICD10CM | Covered |
| F64.2 | ICD10CM | Covered |
|---|
| F64.8 | ICD10CM | Covered |
|---|
| F64.9 | ICD10CM | Covered |
|---|
| N44.00 | ICD10CM | Covered |
|---|
| N45.2 | ICD10CM | Covered |
|---|
| Q53.00 | ICD10CM | Covered |
|---|
| Q53.01 | ICD10CM | Covered |
|---|
| Q53.02 | ICD10CM | Covered |
|---|
| Q53.10 | ICD10CM | Covered |
|---|
| Q53.111 | ICD10CM | Covered |
|---|
| Q53.112 | ICD10CM | Covered |
|---|
| Q53.12 | ICD10CM | Covered |
|---|
| Q53.20 | ICD10CM | Covered |
|---|
| Q53.211 | ICD10CM | Covered |
|---|
| Q53.212 | ICD10CM | Covered |
|---|
| Q53.22 | ICD10CM | Covered |
|---|
| Q53.9 | ICD10CM | Covered |
|---|
| Q55.0 | ICD10CM | Covered |
|---|
| Z87.890 | ICD10CM | Covered |
|---|
| Z90.79 | ICD10CM | Covered |
|---|