Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Blue Cross & Blue Shield of MississippiCommercial · Prior Auth · Medical Policy · MS · Endocrinology, Urology, PediatricsMedium impact

Human Chorionic Gonadotropin

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

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.

Get alerts when payers change rules like this one

We check Blue Cross & Blue Shield of Mississippi and other payers every day and email you when a change matches your specialty and state.

Get Blue Cross & Blue Shield of Mississippi alertsPolicy Monitoring is free. No card required.

What to do

Action · 6 steps
01Get prior authorization before billing Novarel or Pregnyl, because prior authorization is required.
02Bill these drugs for hypogonadism secondary to a pituitary deficiency in males, or for prepubertal cryptorchidism not due to anatomical obstruction.
03Approval length is 12 months for hypogonadism and 4 months for cryptorchidism.
04Do not bill infertility, artificial insemination, intrauterine insemination or in-vitro fertilization services and supplies, which are non-covered regardless of any claim of medical necessity.
05If BCBSMS requests medical records for a medical necessity determination, provide all specific information needed for that determination, because letters of support and explanation are not sufficient on their own.
06Services related to delivery or administration of a medication not approved through the BCBSMS PA review process will be considered not medically necessary.

Codes mentioned

J0725E23.6E29.1Q53.10Q53.12Q53.20Q53.22Q53.9

Original notice

Human Chorionic Gonadotropin
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Luteinizing Hormone (LH) TestingMediumNo effective date · Medical PolicyFree Testosterone TestingMediumNo effective date · Medical PolicyEstrogen Hormone Testing: Estradiol and EstroneMediumNo effective date · Medical PolicyTestosterone Replacement TherapyMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesEndocrinologyUrologyPediatricsCode J0725Code E23.6Code E29.1Code Q53.10Code Q53.12Code Q53.20Code Q53.22Code Q53.9

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account