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.