Chorionic Gonadotropin and Pregnyl will be approved when ALL of the following are met:

1. The requested medication will NOT be used to promote fertility 
   AND
2. The requested medication will NOT be used to treat erectile dysfunction AND
3. ONE of the following: 
   1. The patient has a diagnosis of prepubertal cryptorchidism not due to anatomic obstruction
      OR
   2. The patient’s sex is male with a diagnosis of hypogonadotropic hypogonadism (hypogonadism secondary to pituitary deficiency) AND BOTH of the following:
      1. The patient has a measured current or pretreatment total serum testosterone level that is below the testing laboratory’s lower limit of the normal range or is less than 300 ng/dL OR a free serum testosterone level that is below the testing laboratory’s lower limit of the normal range
         AND
      2. The patient has measured luteinizing hormone (LH) AND follicle-stimulating hormone (FSH) levels that are at (low-normal) or below the testing laboratory’s normal range
         OR
   3. The patient has an indication that is supported in CMS approved compendia for the requested medication
      AND 
4. The patient does NOT have any FDA labeled contraindications to the requested medication

Length of Approval: 12 months