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DESCRIPTIONBoth men and women produce estrogen hormones. Estrogens are responsible for female sexual development and function, such as breast development and the menstrual cycle. In women, estrogens are produced mainly in the ovaries and in the placenta during pregnancy. Small amounts are also produced by the adrenal glands. In men, small amounts of estrogens are produced by the adrenal glands and testicles.
The two major naturally occurring estrogens are estrone (E1) and estradiol (E2).
Estradiol levels are used in evaluating ovarian function. Estradiol levels may be increased in cases of early (precocious) puberty in girls and gynecomastia in men. In males, it may help in the diagnosis of the cause of gynecomastia or in the detection of estrogen-producing tumors. Its main use has been in the differential diagnosis of amenorrhea – for example, to determine whether the cause is menopause, pregnancy, or a medical problem. Estradiol is also sometimes used to monitor menopausal hormone replacement therapy.
Increased levels of estrogens are seen in the following:
Decreased levels of estrogen are seen in the following:
POLICYMeasurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism.
Measurement of estrogen hormones is considered medically necessary to diagnosis hyperestrogenism in symptomatic males.
Measurement of estrogen hormones is considered medically necessary for monitoring hormone replacement therapy in postmenopausal females.
Measurement of estrogen hormones is considered medically necessary for monitoring antiestrogen therapy.
Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients (absence of signs, symptoms, or disease).
POLICY GUIDELINESBenefits will not be provided for the following contract exclusions:
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
10/01/2013: New policy added.
08/28/2015: Medical policy revised to add ICD-10 codes.
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.