Estrogen Hormone Testing: Estradiol and Estrone

POLICY NUMBER

L.2.04.404

DESCRIPTION

Both 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).

• Estrone (E1) is a hormone produced by the ovaries and is the major source of estrogen in women who have gone through menopause. Small amounts of estrone are made throughout the body in most tissues, especially fat and muscle. It also may be measured in men or women who might have cancer of the ovaries, testicles, or adrenal glands.

• Estradiol (E2) is a hormone produced by the ovaries, and levels vary over the course of the menstrual cycle. Levels are usually measured to evaluate early puberty, fertility problems, menstrual problems, menopause, gynecomastia (enlarged breasts in males) or the presence of female sex characteristics, and as a tumor marker for ovarian, testicular, or adrenal gland cancers. Estradiol is the most commonly measured type of estrogen for nonpregnant women. The amount of estradiol in a woman's blood varies throughout her menstrual cycle. After menopause, estradiol production drops to a very low but constant level.

EstroneEstrone levels may be elevated in patients with polycystic ovarian syndrome and endometriosis. Tests may be used to aid in the diagnosis of an ovarian tumor, Turner syndrome, and hypopituitarism.

EstradiolEstradiol is the most important form of estrogen found in the body. Most of it is made in and released from the ovaries, adrenal cortex, and the placenta, which forms during pregnancy to feed a developing baby. Estradiol is responsible for the growth of the womb (uterus), Fallopian tubes, and vagina. It promotes breast development and the growth of the outer genitals. The hormone also plays a role in the distribution of body fat in women.

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:

• Early (precocious) puberty

• Gynecomastia

• Tumors of the ovary, testes, or adrenal glands

Decreased levels of estrogen are seen in the following:

• Turner syndrome

• Hypopituitarism

• Hypogonadism

• After menopause (estradiol)

• PCOS (Polycystic ovarian syndrome, Stein-Levanthal syndrome)  

POLICY

Measurement 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 EXCEPTIONS

None

POLICY GUIDELINES

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:

1. Services and supplies related to infertility, artificial insemination, intrauterine insemination and in-vitro fertilization regardless of any claim of Medical Necessity.

2. For treatment related to sex transformations, sexual function, sexual dysfunctions or inadequacies regardless of Medical Necessity.

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 Mental Health Disorders, 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 medical necessity, “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.

POLICY HISTORY

10/01/2013: New policy added.

08/28/2015: Medical policy revised to add ICD-10 codes.

06/07/2016: Policy number L.2.04.404 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.

09/29/2017: Code Reference section updated to revise description for ICD-10 diagnosis code Z79.890, effective 10/01/2017. Removed deleted ICD-10 diagnosis codes N83.0, N83.1, N83.20, N83.29 and ICD-9 diagnosis codes 620.0, 620.1, and 620.2.

12/16/2020: Code Reference section updated to revise description for CPT code 82670 and to add new CPT code 82681, effective 01/01/2021.

09/28/2022: Policy reviewed. Policy statements unchanged. Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity." Code Reference section updated to add new ICD-10 diagnosis codes N80.00, N80.01, N80.02, N80.03, N80.101, N80.102, N80.103, N80.109, N80.111, N80.112, N80.113, N80.119, N80.121, N80.122, N80.123, N80.129, N80.201, N80.202, N80.203, N80.209, N80.211, N80.212, N80.213, N80.219, N80.221, N80.222, N80.223, N80.229, N80.30, N80.311, N80.312, N80.319, N80.321, N80.322, N80.329, N80.331, N80.332, N80.333, N80.339, N80.341, N80.342, N80.343, N80.349, N80.351, N80.352, N80.353, N80.359, N80.361, N80.362, N80.363, N80.369, N80.371, N80.372, N80.373, N80.379, N80.381, N80.382, N80.383, N80.389, N80.391, N80.392, N80.399, N80.3A1, N80.3A2, N80.3A3, N80.3A9, N80.3B1, N80.3B2, N80.3B3, N80.3B9, N80.3C1, N80.3C2, N80.3C3, N80.3C9, N80.40, N80.41, N80.42, N80.50, N80.511, N80.512, N80.519, N80.521, N80.522, N80.529, N80.531, N80.532, N80.539, N80.541, N80.542, N80.549, N80.551, N80.552, N80.559, N80.561, N80.562, N80.569, N80.A0, N80.A1, N80.A2, N80.A41, N80.A42, N80.A43, N80.A49, N80.A51, N80.A52, N80.A53, N80.A59, N80.A61, N80.A62, N80.A63, N80.A69, N80.B1, N80.B2, N80.B31, N80.B32, N80.B39, N80.B4, N80.B5, N80.B6, N80.C0, N80.C10, N80.C11, N80.C19, N80.C2, N80.C3, N80.C4, N80.C9, N80.D0, N80.D1, N80.D2, N80.D3, N80.D4, N80.D5, N80.D6, and N80.D9, effective 10/01/2022.

10/18/2023: Policy reviewed. Policy statements unchanged. Code Reference section updated to remove deleted ICD-10 diagnosis codes N80.0, N80.1, N80.2, N80.3, N80.4, and N80.5.

12/03/2024: Policy reviewed; no changes.

10/01/2025: Code Reference section updated to add new ICD-10 diagnosis codes C50.A0, C50.A1, and C50.A2.

SOURCE(S)

1. Endocrine Physician Advisory Committee

2. Estradiol test -

   http://www.nlm.nih.gov/medlineplus/ency/article/003711.htm

3. Estrogens

   -

   http://women.webmd.com/estrogens

4. http://labtestsonline.org/understanding/analytes/estrogen/tab/test

5. http://www.labtesthelp.com/test/Estrogen_Fractions

CODE REFERENCE

This 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.

Covered Codes

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