CPT 11980 · Other Procedure
Testopel (testosterone pellet implantation)
Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin).
Free with practitioner sign-in — magic-link email auth, no credit card.
Rubrica tracks payor coverage for CPT 11980 (Testopel (testosterone pellet implantation)) across 64 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 11980
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna Better Health of Florida | Covered | Prior auth |
| Aetna Better Health of Maryland | Covered | Prior auth |
| Aetna Better Health of New Jersey | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Alabama Medicaid | Covered | No PA |
| Alabama Medicaid (FFS) | Covered | Prior auth |
| Allstate Auto / PIP | Covered | Prior auth |
| AmTrust Financial WC | Covered | Prior auth |
| AmeriHealth Caritas Family (ACPA / AC Northeast / Keystone First) — PA HealthChoices | Covered | Prior auth |
| California Medicaid (Medi-Cal) | Covered | No PA |
| CareFirst BCBS Community Health Plan Maryland (CHPMD) | Covered | Prior auth |
| Cigna Medicare / HealthSpring | Covered | Prior auth |
Coverage themes for CPT 11980
Common patterns across the 64 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥12 weeks of conservative care before approving 11980.
Imaging documentation requirements vary by payor.
Of the 64 payors with coverage records for CPT 11980, 32 require prior authorization, 28 cover without prior authorization, and 1 flag the procedure as investigational or experimental under current criteria.
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