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DESCRIPTIONLuteinizing hormone (LH) is a hormone released in both men and women by the anterior pituitary gland in the brain. Production of LH is controlled by the reproductive system, the pituitary gland, and the hypothalamus. Levels of LH in women fluctuate over time. In women, LH levels naturally increase in the middle of the menstrual cycle, causing ovulation. They also increase during menopause. In men, LH stimulates production of the hormone testosterone. Levels of LH remain fairly constant in men.
LH levels are useful in the investigation of menstrual irregularities and to aid in the diagnosis of pituitary disorders or diseases involving the ovaries or testes. LH may also be ordered when a boy or girl does not appear to be entering puberty at an appropriate age (either too late or too soon). Irregular timing of puberty may be an indication of a more serious problem involving the hypothalamus, the pituitary gland, the gonads (ovaries or testes), or other systems. The measurement of LH may differentiate between benign symptoms and true disease.
An abnormally high level of LH in the blood may indicate:
An abnormally low level of LH in the blood may indicate hypopituitarism or Kallmann syndrome.
POLICYMeasurement of luteinizing hormone is considered medically necessary to distinguish between pituitary, hypothalamus, and gonad disorders in males with hypogonadism or hypergonadism.
Measurement of luteinizing hormone is considered medically necessary to distinguish between pituitary, hypothalamus, and gonad disorders in females with symptoms of ovarian dysfunction.
Measurement of luteinizing hormone is considered not medically necessary when performed for screening purposes in asymptomatic patients (absence of signs, symptoms, or disease).
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Benefits will not be provided for the following contract exclusions:
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Nervous/Mental Conditions, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of Medically Necessary, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
10/01/2013: New policy added.
08/18/2015: Medical policy revised to add ICD-10 codes.
06/07/2016: Policy number added. Policy Guidelines updated to add medically necessary definition.
09/30/2016: Code Reference section updated to add the following new ICD-10 diagnosis codes: N83.00 - N83.299 and N93.1.
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.