E29.1 Insurance Policy Changes

ICD-10 E29.1 is officially defined as "Testicular hypofunction." code E29.1 is referenced in 14 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E29.1 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Aug 20, 2026High impact
Bone Densitometry/Bone Density Studies 6.01.05
Effective August 20, 2026, VFA with DEXA and TBS was removed from the list of investigational screening procedures, and DEXA can be completed with or without VFA or TBS. BMD testing is considered medically necessary when one of the listed methods is used, including DEXA, and one of the listed indications is met. Follow-up BMD testing is considered medically appropriate every two years, when at least 23 months have passed since the month of the last test, and testing every three years is recommended after starting bisphosphonate therapy.
Aetna · Identified Oct 5, 2026Medium impact
Therapeutic Phlebotomy (CPB 0652, reviewed 2026-09-25)
Aetna considers therapeutic phlebotomy medically necessary for erythrocytosis of undetermined etiology with a hematocrit of 55% or higher, hemochromatosis (including hereditary hemochromatosis), individuals receiving testosterone therapy with a hematocrit of 54% or higher (or hemoglobin of 180 g/L or higher), non-alcoholic fatty liver disease with hyperferritinemia, non-hereditary hemochromatosis iron overload with elevated hepatic iron concentration, polycythemia vera, polycythemia secondary to arteriovenous fistulae, cor pulmonale or cyanotic congenital heart disease (for hematocrit greater than 60%), porphyria cutanea tarda, and sickle cell crisis. The policy lists acute gouty arthritis, chronic hepatitis C, chronic urticaria, the common cold, hyperferritinemia in alcohol liver disease, hypertension, migraines, myeloproliferative disorders without polycythemia vera, and progressive multiple sclerosis as experimental, investigational or unproven for phlebotomy treatment. CPT 99195 (phlebotomy, therapeutic, separate procedure) is covered if the selection criteria are met.
Aetna · Identified Aug 18, 2026Medium impact
Varicocele: Selected Treatments (CPB 0413, reviewed 2026-06-30)
Aetna considers percutaneous embolization (by balloon or metallic coil) or ligation medically necessary for varicocele when any of these apply: adolescents with grade 2 or 3 varicoceles associated with ipsilateral testicular growth retardation, males with infertility problems who have decreased sperm motility and lower sperm concentrations, post-surgical (ligation) recurrence of varicoceles, or scrotal pain associated with varicoceles. Embolization or ligation for persons who do not meet these criteria is considered experimental, investigational, or unproven, and microsurgical varicocelectomy is considered an acceptable alternative when any of these criteria is met. Adding a sclerosant agent to coil embolization, endoluminal occlusion devices such as the ArtVentive system, endovenous laser ablation of the spermatic vein, surgical treatment for subclinical varicocele, and varicocelectomy for non-obstructive azoospermia are considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Therapeutic Phlebotomy (CPB 0652, reviewed 2025-12-08)
Aetna considers therapeutic phlebotomy medically necessary for erythrocytosis of undetermined etiology with hematocrit of 55% or higher, hemochromatosis including hereditary hemochromatosis, testosterone therapy when hematocrit is 54% or higher or hemoglobin is 180 g/L or higher, non-alcoholic fatty liver disease with hyperferritinemia, non-hereditary hemochromatosis iron overload with elevated hepatic iron concentration, polycythemia vera, porphyria cutanea tarda, and sickle cell crisis. Polycythemia secondary to arterio-venous fistulae, cor pulmonale, or cyanotic congenital heart disease is covered for persons with hematocrit greater than 60%. Aetna considers therapeutic phlebotomy experimental, investigational, or unproven for acute gouty arthritis, chronic hepatitis C as adjunctive therapy with interferon, chronic urticaria, the common cold, hyperferritinemia in alcohol liver disease, hypertension, migraines, myeloproliferative disorders without polycythemia vera, and progressive multiple sclerosis.
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.
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).
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Testosterone Replacement Therapy
Injectable testosterone cypionate and testosterone enanthate do not require prior authorization, and prior authorization is only required for non-injectable testosterone formulations. For Androgel, Testim, or Testopel requests, testosterone replacement is medically necessary when the individual has a documented diagnosis of a pituitary tumor, Klinefelter's syndrome, Kallmann's syndrome, or bilateral orchiectomy, or a documented diagnosis of hypogonadism with signs and symptoms of low testosterone and two low total testosterone levels from morning samples collected between 8:00 a.m. and 10:00 a.m. on different days. Aveed, Axiron, Azmiro, Fortesta, Natesto, Vogelxo, Xyosted, and oral testosterone products are considered not medically necessary because other formulary options exist.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
State and School Employees' Health Insurance Plan - Testosterone Replacement Therapy
Testosterone replacement therapy may be considered medically necessary when the individual has a documented pituitary tumor, Klinefelter's syndrome, Kallmann's syndrome, or bilateral orchiectomy, or a documented diagnosis of hypogonadism with signs and symptoms of low testosterone and two low total testosterone levels from morning samples collected between 8:00 a.m. and 10:00 a.m. on different days. Injectable testosterone cypionate or injectable testosterone enanthate meets the therapy requirement directly, while Testopel requires documentation of an appropriate trial of both injectable products that did not adequately raise testosterone to within normal limits. Aveed and Azmiro are considered not medically necessary because other formulary options exist, and testosterone replacement is not medically necessary if the only symptom is erectile dysfunction or impotence.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Human Chorionic Gonadotropin
Novarel (gonadotropin, chorionic) and Pregnyl (choriogonadotropin alfa) require prior authorization under this BCBSMS policy and are medically necessary for hypogonadism secondary to a pituitary deficiency and for prepubertal cryptorchidism not due to anatomical obstruction. Services and supplies related to infertility, artificial insemination, intrauterine insemination and in-vitro fertilization are non-covered regardless of any claim of medical necessity. The use of samples does not count as current or stable therapy. The most recent update, dated 05/26/2026, left the policy statements unchanged and removed ICD-9 procedure and diagnosis codes from the code reference.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E29.1?

There are 14 tracked policy changes affecting code E29.1, including updates from Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E29.1?

Payers that have issued tracked updates for code E29.1 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code E29.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E29.1. 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 E29.1?

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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Bone Densitometry/Bone Density Studies 6.01.05

Therapeutic Phlebotomy (CPB 0652, reviewed 2026-09-25)

Varicocele: Selected Treatments (CPB 0413, reviewed 2026-06-30)

Therapeutic Phlebotomy (CPB 0652, 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)

Luteinizing Hormone (LH) Testing

Free Testosterone Testing

Estrogen Hormone Testing: Estradiol and Estrone

Testosterone Replacement Therapy

State and School Employees' Health Insurance Plan - Testosterone Replacement Therapy

Human Chorionic Gonadotropin

What insurance policy changes affect code E29.1?

Which payers have updated policy for code E29.1?

How do I get notified when code E29.1 policy changes?

Why do payers change policies for code E29.1?