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DESCRIPTIONProgesterone is a female hormone that prepares the uterus to receive and sustain fertilized eggs. Progesterone is produced principally by the ovary after ovulation. Progesterone serves many purposes, but its principal function is to prepare the lining of the uterus (the endometrium) to allow a fertilized egg to implant and grow. Progesterone is sometimes not produced in adequate amounts or its effect on the lining of the uterus is inadequate. This problem is called luteal deficiency. It is more common in older women and in women with abnormal ovulation.
Men produce some amount of progesterone, but it probably has no normal function except to help produce other steroid hormones.
Progesterone plays a vital role in pregnancy. After an egg is released by the ovaries (ovulation), progesterone helps make the uterus ready for implantation of a fertilized egg. It prepares the womb (uterus) for pregnancy and the breasts for milk production.
Progesterone has characteristics that balance and counteract the adverse effects that estrogen can have. For example, some women produce too much estrogen, thus standing a risk of cancer of the uterus and breast. Supplemental progesterone has been known to aid in managing abnormal uterine bleeding, as well as recurrent pregnancy loss or premature labor.
POLICYMeasurement of progesterone is considered medically necessary in the evaluation of females with symptoms of adrenal or ovarian disease (See Policy Guidelines).
Measurement of progesterone is considered medically necessary to evaluate progesterone levels during pregnancy.
Measurement of progesterone is considered medically necessary to monitor progesterone levels in females receiving supplemental progesterone.
Measurement of progesterone is considered not medically necessary when performed for screening purposes in asymptomatic patients (absence of signs, symptoms, or disease).
POLICY GUIDELINESIncreased progesterone levels also are seen occasionally with:
Low levels of progesterone may be associated with:
Benefits 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.
08/31/2015: 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.