Medical Policy



Subject: Subcutaneous Hormone Replacement Implants
Document #: DRUG.00031 Publish Date:    09/27/2017
Status: Revised Last Review Date:    08/03/2017

Description/Scope

This document addresses indications for the use of subcutaneous hormone implants for the treatment of hormone deficit conditions. This document does not address the use of hormone implants for treatment of other indications for example contraception or treatment of cancer.

Note: This document addresses subcutaneous hormone implants only. This document does not address other formulations of testosterone, such as oral (pill and sublingual), topical (for example, gels), or injectable (intramuscular) medication products.

Please see the following documents for additional information on related topics:

Position Statement

Medically Necessary:

Symptomatic Hypogonadism (Primary or Secondary) in Adults:

I. Subcutaneous testosterone implants used for the initiation of hormone replacement therapy are considered medically necessary when ALL of the following criteria are met (A, B, C, D and E):

  1. Individual is male; and
  2. Individual is 18 years of age or older; and
  3. Prior to starting testosterone therapy, an initial and a repeat (at least 24 hours apart) morning total testosterone level is provided to confirm a low testosterone serum level indicating one of the following (1 or 2);
    1. Individual is 70 years of age or younger with a serum testosterone level of less than 300 ng/dL; or
    2. Individual is over 70 years of age with a serum testosterone level of less than 200 ng/dL; and
  4. Individual has documentation of one of the following conditions (1 or 2):
    1. Primary hypogonadism (congenital or acquired), including, but not limited to one of the following conditions:
      1. Bilateral torsion; or
      2. Cryptorchidism; or
      3. Chemotherapy; or
      4. Klinefelter Syndrome; or
      5. Orchitis; or
      6. Orchiectomy; or
      7. Toxic damage from alcohol or heavy metals; or
      8. Vanishing testis syndrome; or
      9. Idiopathic primary hypogonadism;
        or
    2. Hypogonadotropic hypogonadism (also called secondary hypogonadism) (congenital or acquired), including but not limited to one of the following conditions:
      1. Idiopathic gonadotropic or luteinizing hormone-releasing hormone (LHRH) deficiency; or
      2. Pituitary-hypothalamic injury; and
  5. Individual presents with symptoms associated with hypogonadism, such as, but not limited to at least one of the following (1 through 9):
    1. Reduced sexual desire (libido) and activity; or
    2. Decreased spontaneous erections; or
    3. Breast discomfort/gynecomastia; or
    4. Loss of body (axillary and pubic) hair, reduced need for shaving; or
    5. Very small (especially less than 5 mL) or shrinking testes; or
    6. Inability to father children or low/zero sperm count; or
    7. Height loss, low trauma fracture, low bone mineral density; or
    8. Hot flushes, sweats; or
    9. Other less specific signs and symptoms including decreased energy, depressed mood/dysthymia, irritability, sleep disturbance, poor concentration/memory, diminished physical or work performance.

II. Subcutaneous testosterone implants used for continuation of hormone replacement therapy are considered medically necessary when the criteria for initial therapy were met and ALL the following are met (A, B, and C):

  1. Individual met all diagnostic criteria for initial therapy; and
  2. Individual has had serum testosterone level measured in the previous 180 days; and
  3. Individual has obtained clinical benefits as noted by symptom improvement.

Delayed Puberty:

III. Subcutaneous testosterone implants are considered medically necessary for the treatment of delayed puberty when ALL of the following criteria are met (A, B, and C):

  1. Individual is a male 14 years of age or older; and
  2. Individual is using hormone to stimulate puberty; and
  3. Documentation is provided indicating few to no signs of puberty.

Gender Reassignment:

IV. Subcutaneous testosterone implants are considered medically necessary for transgender individuals when ALL of the following criteria are met (A, B and C):

  1. Individual is 16 years of age or older; and
  2. Individual has a diagnosis of gender dysphoria or gender identity disorder; and
  3. The goal of treatment is female-to-male gender reassignment.

Investigational and Not Medically Necessary:

Subcutaneous testosterone implants are considered investigational and not medically necessary for all indications not listed above.

Subcutaneous hormone implants (estrogen alone OR estrogen combined with testosterone) are considered investigational and not medically necessary for the treatment of hormone deficit conditions, including but not limited to:

  1. Hormone replacement therapy (HRT) for female menopause;
  2. Delayed puberty in females.
Rationale

Testosterone pellets:

Testosterone is an androgen hormone responsible for normal growth and development of male sex characteristics. In certain medical conditions such as hypogonadism, the endogenous level of testosterone falls below normal levels. Primary hypogonadism includes conditions such as testicular failure due to cryptorchidism, bilateral torsion, orchitis, or vanishing testis syndrome; bilateral orchidectomy; and inborn errors in the biosynthesis of testosterone. Secondary hypogonadism, also called hypogonadotropic hypogonadism includes conditions such as gonadotropin-releasing hormone (GnRH) deficiency or pituitary-hypothalamic injury resulting from tumors, trauma, surgery, or radiation.

Testosterone hormone replacement can be delivered by mouth, intramuscular injection, topically, buccally or subcutaneously by testosterone pellets. Testosterone pellets have been approved by the U.S. Food and Drug Administration for the treatment of congenital or acquired androgen deficiency as a result of primary or secondary hypogonadism, or delayed puberty (Product information label, 2016).

According to the American Association of Clinical Endocrinologists (AACE) medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult males (2002 update):

Hypogonadism may manifest with testosterone deficiency, infertility, or both conditions. Symptoms of hypogonadism depend primarily on the age of the male patient at the time of development of the condition. Hypogonadism is often unrecognized before the age of puberty unless it is associated with growth retardation or other anatomic or endocrine abnormalities.

When hypogonadism develops before the age of puberty, the manifestations are those of impaired puberty (for example, gynecomastia; small testes, phallus and prostate; scant pubic and axillary hair; reduced male musculature; persistent high-pitched voice)… Post-pubertal loss of testicular function results in slowly evolving subtle clinical symptoms and signs… Adult males with hypogonadism may exhibit progressive loss of muscle mass; loss of libido; impotence; and oligospermia or azoospermia… In aging men, these symptoms and signs may be difficult to appreciate because they are often attributed to getting older… Hormonal and ancillary testing should be performed to allow pertinent treatment considerations. Testosterone replacement therapy can often enable the patient to function in a more normal manner and decrease the risk of future problems with fertility, mood disturbances, fatigue, impaired virilization, and osteoporosis.

Further studies are needed to determine the influence of testosterone replacement therapy on cardiovascular risk… The ultimate goals are to improve not only the duration but also the quality of life and to allow people to reach their full potential regardless of age.

The Endocrine Society published clinical practice guidelines on Testosterone Therapy in Men with Androgen Deficiency in 2006, with an update published in 2010 (Bhasin). The 2010 guidelines included the following statements on the diagnosis of androgen deficiency and therapy with testosterone replacement:

In 2015, the Endocrine Society added the following amended recommendations:

The Endocrine Society also provided the following list of specific symptoms of hypogonadism:

Regarding hypogonadism associated with male aging, in 2009 the International Society for the Study of Aging Male, the International Society of Andrology, the European Association of Urology, the European Academy of Andrology, and the American Society of Andrology issued joint guidelines on the treatment and monitoring of late-onset hypogonadism which provided the following:

The diagnosis of treatable hypogonadism requires the presence of symptoms and signs suggestive of testosterone deficiency (Grade A recommendation; level of evidence 3). The symptom most associated with hypogonadism is low libido (Grade A recommendation; level of evidence 3). Other manifestations of hypogonadism include erectile dysfunction, decreased muscle mass and strength, increased body fat, decreased bone mineral density and osteoporosis, decreased vitality, and depressed mood. None of these symptoms are specific to the low androgen state but may raise suspicion of testosterone deficiency. One or more of these symptoms must be corroborated with a low serum testosterone level (Grade A recommendation; level of evidence 3).

Presentations of natural testosterone should be used for substitution therapy. Currently available intramuscular, subdermal, transdermal, oral, and buccal preparations of testosterone are safe and effective (Grade A recommendations; level of evidence 1b). The selection of the preparation should be a joint decision of an informed patient and physician (Wang, 2009).

The Endocrine Society Clinical Practice Guideline for Endocrine Treatment of Transsexual Persons recommends that adolescents who fulfill eligibility and readiness criteria for gender reassignment initially undergo treatment to suppress pubertal development which should be initiated at about the age of 16 years, using a gradually increasing dose schedule of cross-sex steroids (Hembree, 2009).

According to Newfield and colleagues (2006):

Masculinizing hormone therapy (the administration of exogenous endocrine agents to induce masculinizing changes) is a medically necessary intervention for many transsexual, transgender, and gender nonconforming individuals with gender dysphoria… In FTM patients, the following physical changes are expected to occur: deepened voice, clitoral enlargement (variable), growth in facial and body hair, cessation of menses, atrophy of breast tissue, and decreased percentage of body fat compared to muscle mass.

Although secondary or tertiary hormonal treatments with androgens are indicated for palliation therapy in post-menopausal women with metastatic breast cancer, subcutaneous testosterone implants are not indicated for these uses and should not be used by females.

Estrogen:

Estrogen is a hormone that occurs naturally, or is manufactured as a synthetic steroidal or nonsteroidal compound with estrogenic activity. Estrogen is used to treat moderate to severe symptoms of female menopause. Estrogen replacement therapy (ERT) indicates the use of estrogen hormone as a single agent. Estrogen in combination with progestin is called hormone replacement therapy (HRT).

Several studies (Holland, 1995; Studd, 1994; Wahab, 1997) measured estrogen implant effect on bone density, which provided objective measurement. There have been relatively few studies in which delivery of estrogen replacement therapy using implants was directly compared with other methods of estrogen administration. However, there are no estrogen formulations for subcutaneous ERT approved by the U.S. Food and Drug Administration (FDA) at this time.

There are several randomized controlled studies and uncontrolled prospective clinical trials evaluating subcutaneous HRT. Subcutaneous HRT was compared with placebo and with oral and transdermal therapy. The studies had relatively few subjects considering the large number of women candidates for HRT. None of the studies was completely blinded. Symptom relief was largely based on subjective and participant reported results. These studies could be subject to bias based on placebo effect. Reported problems with subcutaneous HRT therapy include:

HRT for menopause has been the subject of debate. Additional research is needed to determine the optimal dosage, treatment interval and benefit to risk ratio of hormone replacement therapy as a treatment for menopause. Estrogen compounded with testosterone for subcutaneous HRT is not FDA approved. The published literature does not demonstrate safety and utility in short- or long-term therapy.

Background/Overview

Hormone therapy can be delivered subcutaneously by implantation of the drug in pellet form in the lower abdomen or buttocks. The procedure is done in a physician's office with the use of a local anesthetic and a small incision for insertion. The release of the drug continues over a 3-6 month period, eliminating individual compliance with dosing schedules. Since the drug bypasses the gastrointestinal system and most liver metabolism, bioavailability can be increased. Sustained release can mimic endogenous production achieving therapeutic blood levels.

According to the American Association of Clinical Endocrinologists (AACE, 2002), men with decreased testosterone levels may experience a higher incidence of osteoporosis, sexual dysfunction, fatigue, cardiovascular disease and disturbances in mood.

Testosterone (Testopel® ):

The following are contraindications and warnings from the Product Information Label (2016):

Contraindications

Androgens are contraindicated in men with carcinomas of the breast or with known or suspected carcinomas of the prostate. If administered to pregnant women, androgens cause virilization of the external genitalia of the female fetus. The virilization includes clitoromegaly, abnormal vaginal development, and fusion of genital folds to form a scrotal-like structure. The degree of masculinization is related to the amount of drug given and the age of the fetus, and is most likely to occur in the female fetus when the drugs are given in the first trimester. If the patient becomes pregnant while taking these drugs she should be apprised of the potential hazard to the fetus.

Warnings:

Menopause occurs when the ovaries no longer produce estrogen, causing the reproductive system to shut down and female is free of menses for 1 year. The normal aging process is the usual reason for menopause. However, the loss of estrogen production may also be due to the surgical removal of the ovaries or as a result of treatment with chemotherapy.

According to the AACE (2011), although many women are asymptomatic in menopause, other women in the hypoestrogenic state may experience symptoms that may be severe and have a negative impact on quality of life. Symptoms of estrogen deficiency include hot flashes, sweating, insomnia, and vaginal dryness and discomfort. Hormone replacement therapy goals are to alleviate menopause symptoms, and include estrogen alone or estrogen in combination with testosterone. However, there are currently no implantable hormone pellets approved by the FDA for treatment of symptoms of menopause.

Definitions

Androgen: A general term for any male sex hormone.

Delayed Puberty: The absence or incomplete development of secondary sexual characteristics bounded by an age at which 95% of children of that sex and culture have initiated sexual maturation.  In the United States, the upper 95th percentile for boys to initiate puberty is age 14 (an increase in testicular size being the first sign) and for girls is age 12.

Endogenous: Developing or originating within the body.

Gender Dysphoria (Gender Identity Disorder): Discomfort or distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics).

Hypogonadotropic hypogonadism (congenital or acquired): Idiopathic gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency, or pituitary-hypothalamic injury from tumors, trauma, or radiation.

Menopause: Cessation of menstruation in the human female.

Primary hypogonadism (congenital or acquired): Testicular failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, or orchidectomy.

Subcutaneous: Under the skin.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met for testosterone implants:

CPT  
11980 Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) [when specified as implantation of testosterone pellets]
   
HCPCS  
S0189 Testosterone pellet; 75mg
   
ICD-10 Diagnosis  
E23.0 Hypopituitarism (hypogonadotropic hypogonadism)
E29.1 Testicular hypofunction
E29.8 Other testicular dysfunction
E29.9 Testicular dysfunction, unspecified
E30.0 Delayed puberty
E89.5 Postprocedural testicular hypofunction
F64.0-F64.9 Gender identity disorders
N44.00-N44.04 Torsion of testis
N45.2 Orchitis
N46.11-N46.129 Oligospermia
N52.01-N52.9 Male erectile dysfunction
Q53.00-Q53.9 Undescended and ectopic testicle
Q55.22 Retractile testis
Q98.0-Q98.1 Klinefelter syndrome (karyotype 47 XXY/male with more than two X chromosomes)
Q98.4 Klinefelter syndrome, unspecified
R68.82 Decreased libido
T88.7XXA-T88.7XXS Unspecified adverse effect of drug or medicament

When services are Investigational and Not Medically Necessary:
For the codes listed above when criteria are not met or for the following diagnoses, or when the code describes a procedure indicated in the Position Statement section as investigational and not medically necessary.

ICD-10 Diagnosis  
E28.310-E28.39 Primary ovarian failure
E28.8 Other ovarian dysfunction
E28.9 Ovarian dysfunction, unspecified
E89.40-E89.41 Postprocedural ovarian failure
N95.0-N95.9 Menopausal and other perimenopausal disorders
R53.81-R53.83 Other malaise and fatigue

When services are Investigational and Not Medically Necessary for estradiol or estradiol/testosterone implants:
When the code(s) describes a procedure indicated in the Position Statement section as investigational and not medically necessary.

CPT  
11980 Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) [when specified as implantation of estradiol or combined estradiol/testosterone pellets]
   
HCPCS  
J3490 Unclassified drugs [when specified as estrogen or estrogen/testosterone pellets]
   
ICD-10 Diagnosis  
E28.310-E28.39 Primary ovarian failure
E28.8 Other ovarian dysfunction
E28.9 Ovarian dysfunction, unspecified
E30.0 Delayed puberty
E89.40-E89.41 Postprocedural ovarian failure
F64.0-F64.9 Gender identity disorders
N95.0-N95.9 Menopausal and other perimenopausal disorders
R53.81-R53.83 Other malaise and fatigue
R68.82 Decreased libido
   
References

Peer Reviewed Publications:

  1. Anderson RA, Wallace AM, Sattar N, et al. Evidence for tissue selectivity of the synthetic androgen 7 alpha-methyl-19-nortestosterone in hypogonadal men. J Clin Endocrinol Metab. 2003; 88(6):2784-2793.
  2. Buckler HM, Robertson WR, Wu FC. Which androgen replacement therapy for women? J Clin Endocrinol Metab. 1998; 83(11): 3920-3924.
  3. del Carmen Cravioto M, Larrea F, Delgado NE, et al. Pharmacokinetics and pharmacodynamics of 25-mg estradiol implants in postmenopausal Mexican women. Menopause. 2001; 8(5): 353-360.
  4. File SE, Heard JE, Rymer J. Trough oestradiol levels associated with cognitive impairment in post-menopausal women after 10 years of oestradiol implants. Psychopharmacology. 2002; 161(1): 107-112.
  5. Holland EF, Leather AT, Studd JW. Increase in bone mass of older postmenopausal women with low mineral bone density after one year of percutaneous oestradiol implants. Br J Obstet Gynaecol. 1995; 102(3):238-242.
  6. Howell S, Shalet S. Testosterone deficiency and replacement. Horm Res. 2001; 56 Suppl 1:86-92.
  7. Kelleher S, Conway AJ, Handelsman DJ. Influence of implantation site and track geometry on the extrusion rate and pharmacology of testosterone implants. Clin Endocrinol. 2001; 55(4):531-536.
  8. Kenemans P, van Unnik GA, Mijatovic V, van der Mooren MJ. Perspectives in hormone replacement therapy. Maturitas. 2001 15; 38 Suppl 1:S41-S48.
  9. Newfield E, Hart S, Dibble S, & Kohler L. Female-to-male transgender quality of life. Quality of Life Research. 2006; 15(9):1447-1457.
  10. Studd JWW, Holland EFN, Leather AT, Smith RNJ. The dose-response of percutaneous oestradiol implants on the skeletons of postmenopausal women. Br J Obstet Gynaecol. 1994; 101:787-791.
  11. Suhonen SP, Allonen HO, Lähteenmäki P. Sustained-release estradiol implants and a levonorgestrel-releasing intrauterine device in hormone replacement therapy. Am J Obstet Gynecol. 1995; 172:562-567.
  12. Templeman C, Quinn D, Hansen R, et al. An audit of oestrogen implant hormone replacement therapy. Aust NZ J Obstet Gynaecol. 1998; 38:455-460.
  13. Vogelvang, TE et al. Neither long-term treatment with raloxifene nor hormone replacement therapy modulate cardiac function in healthy postmenopausal women: Two randomized, placebo-controlled, 2-year studies. Am J Obstet Gynecol. 2002; 186(4): 729-736.
  14. Wahab M, Ballard P, Purdie DW, Cooper A, Willson JC. The effect of long-term oestradiol implantation on bone mineral density in postmenopausal women who have undergone hysterectomy and bilateral oophorectomy. Br J Obstet Gynaecol. 1997; 104(6):728-731.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. American Association of Clinical Endocrinologists (AACE). AACE medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocrine Practice. 2011; 1(6): 11-25.
  2. American Association of Clinical Endocrinologists. AACE Medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients, 2002 update. Endocr Pract. 2002; 8: 439-456.
  3. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010; 95(6):2536-1559. Available at: http://press.endocrine.org/doi/full/10.1210/jc.2009-2354. Accessed on June 25, 2017.
  4. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2006; 91(6):1995-2010.
  5. Coleman E, Bockting W, Botzer M, et al. World Professional for Transgender Health (WPATH). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgen. 2011; 13:165-232.
  6. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al. Endocrine treatment of transsexual persons: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009; 94(9):3132-3154.
  7. Seftel AD, Kathrins M, Niederberger C. Critical update of the 2010 Endocrine Society clinical practice guidelines for male hypogonadism: a systematic analysis. Mayo Clin Proc. 2015; 90(8):1104-1115.
  8. Testopel. [Product Information]. Malvern, PA, Endo Pharmaceuticals Inc. October 2016. Available at: http://www.endo.com/File%20Library/Products/Prescribing%20Information/Testopel_prescribing_information.pdf. Accessed on June 25, 2017.
  9. Testosterone. DrugPoints® System (electronic version). Truven Health Analytics, Greenwood Village, CO. Updated June 9, 2016. Available at: http://www.micromedexsolutions.com. Accessed on June 25, 2017.
  10. Testosterone Monograph. Lexicomp® Online, American Hospital Formulary Service® (AHFS® ) Online, Hudson, Ohio, Lexi-Comp., Inc. Last revised October 25, 2016. Accessed on June 25, 2017.
  11. Wang C, Nieschlag E, Swerdloff R, et al. International Society for the Study of Aging Male, the International Society of Andrology, the European Association of Urology, the European Academy of Andrology, and the American Society of Andrology (ISSAM/ISA/EAU/EAA/ASA). Investigation, treatment, and monitoring of late-onset hypogonadism in males: recommendations. Eur Urol. 2009; 55(1):121-130.
Websites for Additional Information
  1. National Institute on Aging. Menopause. Last update June 10, 2015. Available at: https://www.nia.nih.gov/health/publication . Accessed on June 25, 2017.
  2. National Institutes of Health. Menopausal Hormone Therapy Information. Last reviewed April 25, 2016. Available at: http://www.nih.gov/PHTindex.htm. Accessed on June 25, 2017.
  3. U.S. Food and Drug Administration. Drug Information. Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women. Updated June 22, 2010. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm135318.htm. Accessed on June 25, 2017.
Index

Estrogen and Testosterone Subcutaneous Hormone Implants
Hormone Implants
Testosterone pellets (Testopel)
Testosterone Subcutaneous Hormone Implants

Document History
Status Date Action
Revised 08/03/2017 Medical Policy & Technology Assessment Committee (MPTAC) review. Reformatted MN section adding header to separate the MN indications. Updated Rationale, Background, Coding, References and Websites sections.
Revised 08/04/2016 MPTAC review. Added MN criteria for initiation and continuation of subcutaneous hormone therapy for treatment of males with congenital or acquired endogenous androgen absence or deficiency associated with primary or secondary hypogonadism. Added MN statement for subcutaneous testosterone implants for treatment of delayed puberty and transgender individuals. Revised I/NMN statement for subcutaneous hormone implants (estrogen alone OR estrogen combined with testosterone). Updated Description, Discussion, Definitions, References and Websites. Updated Coding section to include 10/01/2016 ICD-10-CM changes and removed ICD-9 codes.
Reviewed 08/06/2015 MPTAC review. Updated Rationale, Background, References and Websites.
Reviewed 08/14/2014 MPTAC review. Description, Rationale, Background and Websites updated.
Reviewed 08/08/2013 MPTAC review. Updated Description, Background, References and Websites.
Reviewed 08/09/2012 MPTAC review. Updated References, Coding and Websites.
Reviewed 08/18/2011 MPTAC review. Definitions, References and Websites updated.
Reviewed 08/19/2010 MPTAC review. Websites and References updated.
Reviewed 08/27/2009 MPTAC review. References updated.
Revised 08/28/2008 MPTAC review. Updated review date, coding and references. Additional investigational and not medically necessary statement added. Title updated to include "Subcutaneous."
  02/21/2008 The phrase "investigational/not medically necessary" was clarified to read "investigational and not medically necessary." This change was approved at the November 29, 2007 MPTAC.
Reviewed 08/23/2007 MPTAC review. Clarified description on hormone replacement implants. Updated rationale, background, references and websites. No changes to position.
Reviewed 09/14/2006 MPTAC review. Updated review date, coding and references. No changes to position.
Revised 09/22/2005 MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
Pre-Merger Organizations

Last Review Date

Document Number Title
Anthem, Inc.

 

  No prior document
WellPoint Health Networks, Inc.

9/23/2004

8.09.01 Hormone Implants