E23.0 Insurance Policy Changes

ICD-10 E23.0 is officially defined as "Hypopituitarism." code E23.0 is referenced in 16 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E23.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Human Growth Hormone and Insulin-like Growth Factor-1
Already effective 2025-10-01: Prior authorization is required for the growth hormone products listed in this policy, and the policy criteria were extensively revised. Use of samples by an individual will not be considered current or stable therapy to satisfy policy requirements. Egrifta SV and Egrifta WR are considered not medically necessary because the reduction of excess abdominal fat is considered cosmetic, and Genotropin, Humatrope, Ngenla, Omnitrope, Skytrofa, Sogroya and Zomacton are considered not medically necessary because other formulary alternatives are covered by the plan.
Aetna · Effective Aug 12, 2025Medium impact
Human Chorionic Gonadotropin (hCG) (CPB 1081, reviewed 2026-10-08)
Aetna considers chorionic gonadotropin products (Novarel, Pregnyl, Ovidrel and generic hCG) medically necessary for induction of oocyte maturation or release in assisted reproductive technology or ovulation induction, prepubertal cryptorchidism not due to anatomical obstruction, hypogonadotropic hypogonadism meeting listed criteria for inducing spermatogenesis, and steroid-refractory acute graft-versus-host disease under listed conditions. Use for endometrium preparation alone for frozen embryo transfer, idiopathic male infertility, idiopathic microphallus and obesity or weight loss is considered experimental, investigational or unproven.
Aetna · Effective Aug 12, 2025Medium impact
Follitropins and Menotropins (CPB 1082, reviewed 2026-10-09)
Aetna considers follitropins (Gonal-F, Follistim AQ) and menotropins (Menopur) medically necessary for ovulation induction or assisted reproductive technology when the member has completed three or more previous cycles of clomiphene or letrozole, has a risk factor for poor ovarian response to clomiphene or letrozole, has a contraindication or exclusion to them, or is 37 years of age or older. Follitropins are also considered medically necessary for hypogonadotropic hypogonadism treatment that meets listed testosterone and FSH or LH criteria. Commercial plans may require a trial of a lower-cost preferred drug before a higher-cost drug in the same therapeutic class is approved. Use solely for endometrium preparation for frozen embryo transfer, and menotropins for male infertility, are considered experimental, investigational or unproven.
Aetna · Identified Oct 13, 2026Medium impact
Tubal Sterilization (CPB 0657, reviewed 2026-10-07)
Aetna considers electrocoagulation, the Falope ring, the Filshie clip, the Hulka-Clemens clip, partial salpingectomy (Pomeroy and Parkland techniques) and total salpingectomy medically necessary for tubal sterilization. Aetna considers hysteroscopic tubal sterilization, including the Essure Micro-Insert, and the FemBloc permanent contraceptive system experimental, investigational, or unproven because their safety and long-term effects have not been established. CPT codes 58340, 58600, 58605, 58611, 58615, 58661, 58670, 58671, 58700 and 74740 are covered when selection criteria are met.
Aetna · Identified Aug 18, 2026Medium impact
Tubal Sterilization (CPB 0657, reviewed 2025-12-08)
Aetna considers electrocoagulation, the Falope ring, the Filshie clip, the Hulka-Clemens clip, partial salpingectomy (Pomeroy and Parkland techniques) and total salpingectomy medically necessary for tubal sterilization. Hysteroscopic tubal sterilization, such as the Essure Micro-Insert, and the FemBloc permanent contraceptive system are considered experimental, investigational, or unproven for birth control and all other indications because their safety and long-term effects have not been established. The manufacturer (Hologic) has discontinued production of the Adiana Permanent Contraception System.
Aetna · Identified Aug 18, 2026Medium impact
Testosterone Undecanoate (Aveed) Injection (CPB 0528, reviewed 2026-07-09)
Aetna's clinical policy for testosterone undecanoate (Aveed) injection covers it for commercial medical plans when it is medically necessary for primary hypogonadism or hypogonadotropic hypogonadism, or for gender dysphoria when prescribed for gender-affirming care, in each case under the listed criteria. Precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers age-related (late-onset) hypogonadism an exclusion for testosterone undecanoate therapy, and considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Testosterone Cypionate Injections (CPB 1014, reviewed 2026-07-13)
Aetna's clinical policy for testosterone cypionate injection (Azmiro, Depo-Testosterone or generic formulation) covers it for commercial medical plans when it is medically necessary for primary or hypogonadotropic hypogonadism, or for gender dysphoria when prescribed for gender-affirming care, under the listed criteria. For hypogonadism, the member must have at least two confirmed low morning testosterone levels before therapy starts. Continuation for hypogonadism requires a confirmed low morning testosterone level before the start of therapy. Aetna considers age-related or late-onset hypogonadism, female sexual dysfunction or hypoactive sexual desire disorder, heart failure, menopause, hormonal replacement in prostate cancer survivors with testosterone deficiency, and improvement of cognitive function in aging men experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Testosterone Enanthate Injection (CPB 1015, reviewed 2026-07-17)
Aetna's clinical policy for intramuscular testosterone enanthate injection (generic Delatestryl) covers it for commercial medical plans when it is medically necessary for hormone-responsive breast cancer in a premenopausal member who has benefited from oophorectomy, delayed puberty, gender dysphoria when prescribed for gender-affirming care, inoperable metastatic breast cancer in a member 1 to 5 years postmenopausal with an incomplete response to other therapy, or primary or hypogonadotropic hypogonadism with at least two confirmed low morning testosterone levels before therapy. Aetna considers age-related or late-onset hypogonadism, female sexual dysfunction or hypoactive sexual desire disorder, heart failure, and improvement of cognitive function in aging men experimental, investigational, or unproven. The brand Delatestryl has been discontinued in the U.S., and an FDA-approved generic equivalent is available.
Aetna · Identified Aug 15, 2026Medium impact
Implantable Hormone Pellets (CPB 0345, reviewed 2026-07-08)
Reviewed 2026-07-08, Aetna Clinical Policy Bulletin 0345 covers implantable hormone pellets for commercial medical plans. Estradiol pellets are considered experimental, investigational, or unproven because they produce unpredictable and fluctuating serum estrogen concentrations. Testosterone propionate implant pellets (Testopel) are considered medically necessary for delayed male puberty, for gender dysphoria under the listed criteria, and for primary or hypogonadotropic hypogonadism when at least two confirmed low morning testosterone levels are documented before therapy starts. Age-related hypogonadism is an exclusion for testosterone implant pellets. Progestin and progesterone pellets are considered experimental for dysmenorrhea and erythema nodosum.
Aetna · Identified Aug 15, 2026Medium impact
Growth Hormone (GH) and Growth Hormone Antagonists (CPB 0170, reviewed 2026-06-26)
Aetna considers somatropin products (Genotropin, Humatrope, Norditropin, Nutropin AQ, Omnitrope, Saizen and Zomacton), Serostim, Sogroya (somapacitan-beco), Skytrofa (lonapegsomatropin-tcgd) and Somavert (pegvisomant) medically necessary for the listed indications when the criteria for each are met, and considers all other indications experimental, investigational or unproven. The criteria cover pediatric growth hormone deficiency, SGA, Turner syndrome, Prader-Willi syndrome, SHOX deficiency, Noonan syndrome, growth failure from CKD, cerebral palsy, congenital adrenal hyperplasia, cystic fibrosis and Russell-Silver syndrome, adult growth hormone deficiency, HIV-associated wasting or cachexia, and acromegaly. Idiopathic short stature is not considered an illness, so GH is not a covered plan benefit where the plan covers only treatment of disease, illness or injury.
Aetna · Identified Aug 15, 2026Medium impact
Follitropins and Menotropins (CPB 1082, reviewed 2026-04-10)
Aetna considers follitropins (Follistim AQ, Gonal-F, Gonal-F RFF) and menotropins (Menopur) medically necessary for commercial medical plans when the criteria in the bulletin are met. For follicle stimulation in assisted reproductive technology or ovulation induction, the member must have completed three or more cycles of clomiphene or letrozole, have a risk factor for poor ovarian response, have a contraindication or exclusion to clomiphene or letrozole, or be 37 years of age or older. Treatment of hypogonadotropic hypogonadism with follitropins for induction of spermatogenesis requires at least two confirmed low pretreatment serum total testosterone levels taken in the morning on separate days plus low or low-normal FSH or LH, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Distraction Osteosynthesis (CPB 0220, reviewed 2026-04-09)
Aetna considers the Ilizarov method for distraction osteosynthesis medically necessary for members with an angular or rotational deformity of a long bone, a bone defect, or a limb length discrepancy who also meet one of the listed selection criteria, such as a leg length discrepancy of more than 4 cm, an arm length discrepancy of more than 5 cm, or a long bone fracture not healed in 6 or more months after electrical stimulation and bone grafting have failed. The PRECICE intramedullary limb lengthening system is considered medically necessary for lengthening the tibia and femur in persons with a leg length discrepancy of more than 4 cm. Ilizarov use for other indications, the intramedullary skeletal kinetic distractor, pulsed ultrasound as an adjuvant therapy, and Phenix nails are considered experimental, investigational or unproven, and Ilizarov use to correct short stature is considered cosmetic.
Aetna · Identified Aug 13, 2026Medium impact
Progestins (CPB 0510, reviewed 2026-07-13)
Aetna considers medroxyprogesterone acetate injection (Depo-Provera CI or generic 150 mg/mL) medically necessary for pregnancy prevention and for gender dysphoria when the listed criteria are met. It considers the etonogestrel subdermal implant (Nexplanon) medically necessary for pregnancy prevention and for primary or secondary dysmenorrhea associated with endometriosis in adolescents, and it considers progestin-releasing IUDs (Kyleena, Mirena, Skyla and Liletta) medically necessary for contraception or heavy menstrual bleeding. Progesterone intramuscular injection is medically necessary for amenorrhea or abnormal uterine bleeding due to hormonal imbalance without organic pathology, and the policy considers it experimental, investigational, or unproven for other indications, including pregnancy prevention, twin pregnancies, endometrial hyperplasia, premenstrual syndrome and stroke.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Luteinizing Hormone (LH) Testing
Measurement of luteinizing hormone is medically necessary to distinguish between pituitary, hypothalamus and gonad disorders in males with hypogonadism or hypergonadism. It is also medically necessary for females with symptoms of ovarian dysfunction. Measurement of luteinizing hormone is not medically necessary when performed for screening in asymptomatic patients.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Free Testosterone Testing
Serum free testosterone (CPT 84402) is medically necessary to distinguish a sex hormone-binding globulin (SHBG) abnormality from hypogonadism in obese males with symptoms of hypogonadism when total testosterone is low, to diagnose hyperandrogenism in symptomatic females, and in patients with a medical diagnosis that may increase or decrease SHBG levels. It is not medically necessary to diagnose testosterone deficiency in non-obese males with symptoms of hypogonadism, or when performed for screening of asymptomatic patients. Free testosterone should be performed by equilibrium dialysis, and free testosterone measured by an analog method should never be ordered.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Estrogen Hormone Testing: Estradiol and Estrone
Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism, to diagnose hyperestrogenism in symptomatic males, to monitor hormone replacement therapy in postmenopausal females, and to monitor antiestrogen therapy. Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients. The covered tests are total estradiol (CPT 82670), fractionated estrogens (CPT 82671), total estrogens (CPT 82672), estrone (CPT 82679), and free estradiol by direct measurement, such as equilibrium dialysis (CPT 82681).

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E23.0?

There are 16 tracked policy changes affecting code E23.0, including updates from Blue Cross & Blue Shield of Mississippi, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E23.0?

Payers that have issued tracked updates for code E23.0 include: Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when code E23.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E23.0. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code E23.0?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Human Growth Hormone and Insulin-like Growth Factor-1

Human Chorionic Gonadotropin (hCG) (CPB 1081, reviewed 2026-10-08)

Follitropins and Menotropins (CPB 1082, reviewed 2026-10-09)

Tubal Sterilization (CPB 0657, reviewed 2026-10-07)

Tubal Sterilization (CPB 0657, reviewed 2025-12-08)

Testosterone Undecanoate (Aveed) Injection (CPB 0528, reviewed 2026-07-09)

Testosterone Cypionate Injections (CPB 1014, reviewed 2026-07-13)

Testosterone Enanthate Injection (CPB 1015, reviewed 2026-07-17)

Implantable Hormone Pellets (CPB 0345, reviewed 2026-07-08)

Growth Hormone (GH) and Growth Hormone Antagonists (CPB 0170, reviewed 2026-06-26)

Follitropins and Menotropins (CPB 1082, reviewed 2026-04-10)

Distraction Osteosynthesis (CPB 0220, reviewed 2026-04-09)

Progestins (CPB 0510, reviewed 2026-07-13)

Luteinizing Hormone (LH) Testing

Free Testosterone Testing

Estrogen Hormone Testing: Estradiol and Estrone

What insurance policy changes affect code E23.0?

Which payers have updated policy for code E23.0?

How do I get notified when code E23.0 policy changes?

Why do payers change policies for code E23.0?