Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut CG-LAB-27 Human Chorionic Gonadotropin Testing Form

Effective Date

06/28/2023

Last Reviewed

05/11/2023

Original Document

  Reference



This document addresses laboratory testing of human chorionic gonadotropin (hCG) in urine or serum.

Clinical Indications

Medically Necessary:

Urine hCG testing is considered medically necessary for confirming the presence or absence of pregnancy.

Blood hCG testing is considered medically necessary for any of the following indications:

  1. Confirming presence or absence of pregnancy; or
  2. Screening pregnant individuals for fetal abnormalities; or
  3. Hypertensive disorders of pregnancy; or
  4. Gestational trophoblastic neoplasia or molar pregnancy; or
  5. Evaluation of germ cell tumors; or
  6. Testicular cancer or suspicious testicular mass; or
  7. Ovarian cancer; or
  8. Pelvic mass; or
  9. Mediastinal mass; or
  10. Retroperitoneal mass; or
  11. Thymomas or thymic cancer; or
  12. Cancer of unknown primary

Not Medically Necessary:

Urine or blood hCG testing is considered not medically necessary when the above criteria are not met.