2020 Infertility Mandate PA Coding

01/02/2020

New York State recently passed legislation that requires insurers like EmblemHealth to update the infertility services coverage they provide to members as policies issue, renew or are amended on and after January 1, 2020. EmblemHealth will comply with the state mandate for IVF and fertility preservation by adding five new CPT codes to our revised 2020 preauthorization list; five CPT codes will also be removed from this list. The IVF law requires large group medical plans to cover three cycles of IVF used in the treatment of infertility. The fertility preservation law requires individual, small, and large group insurance policies or contracts to provide coverage of fertility preservation services for iatrogenic infertility. 
 

The new CPT codes are:
 

List of 2020 Commercial PA Codes
Adding for 2020 Infertility Mandate

Description of Codes

89337

Cryopreservation, mature oocyte(s) 

89343

Storage (per year); sperm/semen 

89346

Storage (per year); oocyte(s) 

S4016

Frozen in vitro fertilization cycle, case rate 

S4035

Stimulated intrauterine insemination (IUI), case rate


We will be removing the following CPT codes:
 

List of 2020 Commercial PA Codes
Removing for 2020 Infertility Mandate

Description of Codes

58976

Gamete, zygote, or embryo intrafallopian transfer, any method (Only CCI)

S4013

Complete cycle, gamete intrafallopian transfer (GIFT), case rate (CCI only)

S4014

Complete cycle, zygote intrafallopian transfer (ZIFT), case rate (CCI only)

S4026

Procurement of donor sperm from sperm bank

S4028

Microsurgical epididymal sperm aspiration (MESA) (CCI only)

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