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Prior Authorization

Growth Hormone

Required Information for Growth Hormone Pediatric
0 – 18 years

Need good history and physical prior to beginning Growth hormone to include:

  1. Two height measurements by stadiometer at least 6 months apart or at least 2 measurements non-stadiometer over 18 month period
  2. Results of 2 growth hormone stimulation tests and IGF-1 level
  3. Percentile of weight
  4. Current growth chart
  5. Percentile of height
  6. All patient 14 or over must have a current bone age x-ray report

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