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J Code - J 0725
Therapeutic area - Fertility, prevent spontaneous recurrent miscarriage

Drug - Novarel (gonadotropin,chorionic,human)
Therapeutic area - Fertility, Male hypogonadism

Drug - Synarel (nafarelin acetate) (Synthetic gonadotropin releasing hormone)
Therapeutic area - Fertility, endometriosis, central precocious puberty

August 2008

Criteria J 0725

Human Chorionic Gonadotropin (hCG) (1,000 IU)

  • May not be used for fertility, for ovulation, or to help conception occur
  • May be authorized for payment for prevention of spontaneous, recurrent, miscarriage

Criteria Novarel

Alternative names: Chorex, Pregnyl, Profasi

  • Novarel is not to be covered for fertility, for ovulation or to help conception occur
  • Novarel may be used for cryptorchidism and hypogonadism in male children

Criteria Synarel

  • Synarel is not to be covered for fertility
  • May be approved for endometriosis and central precocious puberty


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