Billing and Coding: Treatment of Males with Low Testosterone

Medicare Coverage Database article A58828

Article

Contractor: Palmetto GBA
States (A/B MAC): AL, GA, NC, SC, TN, VA, WV
Effective: Oct 1, 2026
Contractor numbers: 10111, 10112, 10211, 10212, 10311, 10312, 11201, 11202, 11301, 11302, 11401, 11402, 11501, 11502
Official article: A58828 on cms.gov (version 18)

Read the article's coding instructions on CMS — which codes go together, documentation, and frequency limits — before billing. CodeRx lists the codes, not the instructions.

Drug codes in this article

HCPCS Level II drug codes the article lists (other codes it lists are not shown).

Covered ICD-10-CM codes (39)

Diagnosis codes the article lists as supporting medical necessity, grouped as in the article, with CMS's descriptions.

D35.2Benign neoplasm of pituitary gland
D44.3Neoplasm of uncertain behavior of pituitary gland
E23.0Hypopituitarism
E23.1Drug-induced hypopituitarism
E23.3Hypothalamic dysfunction, not elsewhere classified
E23.6Other disorders of pituitary gland
E23.7Disorder of pituitary gland, unspecified
E29.1Testicular hypofunction
E29.8Other testicular dysfunction
E30.0Delayed puberty
E89.5Postprocedural testicular hypofunction
F64.0Transsexualism
F64.1Dual role transvestism
F64.2Gender identity disorder of childhood
F64.8Other gender identity disorders
F64.9Gender identity disorder, unspecified
N44.00Torsion of testis, unspecified
N44.01Extravaginal torsion of spermatic cord
N44.02Intravaginal torsion of spermatic cord
N44.03Torsion of appendix testis
N44.04Torsion of appendix epididymis
N45.2Orchitis
N50.89Other specified disorders of the male genital organs
Q53.00Ectopic testis, unspecified
Q53.01Ectopic testis, unilateral
Q53.02Ectopic testes, bilateral
Q53.10Unspecified undescended testicle, unilateral
Q53.111Unilateral intraabdominal testis
Q53.112Unilateral inguinal testis
Q53.12Ectopic perineal testis, unilateral
Q53.20Undescended testicle, unspecified, bilateral
Q53.211Bilateral intraabdominal testes
Q53.212Bilateral inguinal testes
Q53.22Ectopic perineal testis, bilateral
Q53.9Undescended testicle, unspecified
Q55.0Absence and aplasia of testis
Z79.890Hormone replacement therapy
Z87.8904Personal history of intersex surgery
Z90.79Acquired absence of other genital organ(s)

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