All medical, surgical, and diagnostic services performed to diagnose and treat infertility aregenerallycovered unless the individual member’s contract contains exclusion with regard to the diagnosis and treatment of infertility.
Once it has been established that the ultimate goal for the infertile patient is assisted reproductive technology (IVF, GIFT, ZIFT, etc.), all subsequent related diagnostic, medical, and surgical services are considered part of the assisted reproductive technology program, and are non-covered when the member does not have an assisted reproductive technology benefit.
Related services, including but not limited to lab work and ultrasound, performed in preparation for or in conjunction with assisted reproductive technology services should be reported withthe appropriate diagnosiscode forIVF, GIFT, ZIFT, etc.in order to distinguish them as services associated with assisted reproductive technology program. Such services are non-covered when the member does not have the benefit for assisted reproductive technology.
When reported, assisted reproductive technology program management should be processed under the appropriate procedure codes for the services rendered. Assisted reproductive technology program management generally includes, but is not limited to such services as:
- A history and physical; and
- Daily visits; and
- Consultations for medication adjustment; and
- Counseling.
Report the appropriate diagnosiscodefor IVF, GIFT, ZIFT, etc.in order to distinguish them as services associated with an assisted reproductive program. Such services are non-covered when the member does not have an assisted reproductive technology benefit.
Procedure Codes
| 58321 | 58322 | 58974 | 58976 | 76830 | 76856 | 76857
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