J1073 Testosterone pellet 75 mgTestosterone pellet, implant, 75 mg
Status E: excluded from the PFS by regulation.
23 of 23 payer prior-auth lists that name J1073 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California Promise Health Plan, Cigna, HealthSpring, Humana, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of New Mexico, Passport by Molina Healthcare (Kentucky), UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | AZ Blue-administered Medicare Advantage (M2K) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth required | site of care: site-of-service review | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | site of care: site-of-service review | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Teamsters group (TYW) | AZ | prior auth required | Sep 1, 2026 | Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) | |
| Blue Shield of California Promise Health Plan | Promise Health Plan Medi-Cal | CA | prior auth required | Sep 1, 2026 | Medi-Cal Prior Authorization List | |
| Cigna | ACA/IFP | All | prior auth required | Jan 1, 2026 | Master Precertification List (For Health Care Providers) | |
| Cigna | Basic Standard | All | prior auth required | Jan 1, 2026 | Master Precertification List (For Health Care Providers) | |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | Jan 1, 2026 | Master Precertification List (For Health Care Providers) | |
| HealthSpring | Medicare Advantage | All | prior auth required | Apr 1, 2026 | 2026 Q4 Prior Authorization List | |
| Humana | Humana Healthy Horizons | FL | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Florida Prior Authorization and Notification List | |
| Humana | Humana Healthy Horizons | KY | prior auth required | Oct 7, 2026 | Humana Healthy Horizons in Kentucky Prior Authorization and Notification List | |
| Humana | Humana Healthy Horizons | OH | prior auth required | Oct 14, 2026 | Humana Healthy Horizons in Ohio prior authorization and notification List | |
| Humana | Humana Healthy Horizons | OK | prior auth required | Oct 14, 2026 | Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List | |
| Humana | Humana Healthy Horizons | SC | prior auth required | Oct 14, 2026 | Humana Healthy Horizons in South Carolina prior authorization and notification list | |
| Humana | Humana Healthy Horizons | VA | prior auth required | Oct 14, 2026 | Humana Healthy Horizons in Virginia professionally administered medication prior authorization and notification list | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jan 1, 2026 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of New Mexico | Medicaid | NM | prior auth required | Jan 1, 2026 | New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | Jan 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 | |
| UnitedHealthcare Community Plan | Pennsylvania CHIP | PA | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026 | |
| UnitedHealthcare Community Plan | Pennsylvania Medicaid | PA | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026 |
J1073 appears in 17 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Cigna, Premera Blue Cross, UnitedHealthcare, Wellmark Blue Cross Blue Shield.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Dry Eyes (0457) | not covered | Jul 29, 2026 | payer document |
| Aetna | Implantable Hormone Pellets (0345) | covered if criteria are met | Jul 8, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J0278-J2543) | Mar 5, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Hormone Pellet Implantation For Hormone Replacement Therapy Hrt In Women (L.5.01.500) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Testosterone Replacement Therapy (S.5.01.477) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Testosterone Replacement Therapy (L.5.01.477) | covered if criteria are met | payer document | |
| BlueCross BlueShield of South Carolina | Testosterone Replacement Therapies (CAM 50123) | listed, no stance | Apr 1, 2026 | payer document |
| Capital Blue Cross | Subcutaneous Hormone Pellet Implants (MP 2.345) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Centene | Testosterone (CP.CPA.291) | covered if criteria are met | Nov 1, 2025 | payer document |
| Cigna | Testosterone (Injectable) Products (IP0351) | covered if criteria are met | Dec 15, 2025 | payer document |
| Premera Blue Cross | Medical Necessity Criteria for Pharmacy Edits | listed, no stance | Sep 8, 2026 | payer document |
| UnitedHealthcare | Maximum Dosage and Frequency (CS2026D0034AV) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Maximum Dosage and Frequency (2026D0034AU) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Maximum Dosage and Frequency (for Pennsylvania Only) (CSPA2026D0034AS) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Testosterone Replacement or Supplementation Therapy (CS2026D0076Q) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Testosterone Replacement or Supplementation Therapy (2026D0076J) | listed, no stance | Jan 1, 2026 | payer document |
| Wellmark Blue Cross Blue Shield | Testosterone Agents – Topical/Buccal/Nasal/Implant/Oral/Injection (05.01.45) | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in MS, NE, VT, WA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.