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

DEADLINE: By July 9, 2026, billing and clinical teams must implement the following: (1) Billing team: Update billing system to require precertification for ALL J3145 claims by calling (866) 752-7021 or faxing (888) 267-3277 before claim submission. Do NOT bill without proof of precertification. (2) Providers: Stop prescribing Aveed for age-related/late-onset hypogonadism—this indication is now excluded. (3) Clinical staff: For hypogonadism cases, ensure documentation includes TWO confirmed low serum total testosterone tests (morning, separate days) from reference lab before precertification request. (4) For gender dysphoria cases: Verify member diagnosis (F64.0-F64.9), informed consent documentation, comorbidity control, side effect/contraindication education, and fertility preservation counseling are documented in chart before submitting precertification. (5) For adolescent gender dysphoria: Additionally verify Tanner stage 2+ documentation. (6) Providers: Add gender dysphoria cases to mental health collaboration requirement if member is under 18. (7) Create precertification denial protocol: Deny any claims submitted without required precertification documentation. (8) Front desk/authorization staff: Route all Aveed requests to precertification team immediately upon request—do not process without approval. Failure to obtain precertification will result in claim denials.