TRT Insurance Coverage FAQ
3 questions answered about insurance coverage for testosterone replacement therapy.
Is TRT covered by insurance?
Yes, testosterone replacement therapy is often covered by insurance when you have a documented diagnosis of hypogonadism (low testosterone) with two morning blood tests showing levels below 300 ng/dL. Brand-name testosterone cypionate is the most commonly covered form. Prior authorization is usually required.
How do I get insurance to cover TRT?
To get insurance coverage for TRT, you need a formal diagnosis of hypogonadism (ICD-10 code E29.1) supported by two morning testosterone blood tests below 300 ng/dL, taken before 10 AM. Your physician will submit a prior authorization with lab results and clinical documentation of symptoms.
Does Medicare cover TRT?
Medicare Part D may cover testosterone replacement therapy when prescribed for a documented diagnosis of hypogonadism. Coverage varies by plan formulary and typically requires prior authorization. Generic testosterone cypionate is the most likely to be covered. Contact your Part D plan directly for specific coverage details.