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

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.