Anthem Blue Cross ConnecticutCommercial Clinical Policy

CG-LAB-27 Human Chorionic Gonadotropin Testing Form

Chat with GenHealth to automate any policy or prior auth task.


Urine hCG Testing

Indications

(87046) Is the urine hCG test being used to confirm the presence or absence of pregnancy? 

Contraindications

(87047) Is the urine hCG test being used for any other reason than confirming the presence or absence of pregnancy? 

Blood hCG Testing

Indications

(87048) Is the blood hCG test being used to confirm the presence or absence of pregnancy? 
(87049) Is the blood hCG test being used for screening pregnant individuals for fetal abnormalities? 
(87050) Is the blood hCG test being used in relation to hypertensive disorders of pregnancy? 

YesNoN/A
YesNoN/A
YesNoN/A

Sign up to see the rest of the questions

Unlock the remaining questions and the full coverage workflow.

Sign up for free
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.

Book a walkthrough

Walk through this policy with us

Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.