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type: id
category: medical
person: 
date: 
provider: Progyny
source: progyny_treatment_codes.pdf
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# Progyny Fertility Exclusive Treatment Codes List

We request that claims administrators discontinue approval for the following **fertility exclusive treatment codes**. Claims submitted with the CPT codes listed below should be approved only when submitted by Progyny. *Rejection edit may say, "Member to use their fertility and family building benefit, Progyny. Please call a Patient Care Advocate at:* 844-734-8366 *to learn more.*

## Treatment Codes

| Code | Description |
|---|---|
| S4016 | Frozen In Vitro Fertilization Cycle, Case Rate |
| S4011 | In vitro fertilization; including but not limited to identification and incubation of mature oocytes, fertilization with sperm, incubation of embryo(s), and subsequent visualization for determination of development |
| S4037 | Cryopreserved embryo transfer, case rate |
| S4013 | Complete cycle, gamete intrafallopian transfer (GIFT), case rate |
| S4014 | Complete cycle, zygote intrafallopian transfer (ZIFT), case rate |
| S4015 | Complete in vitro fertilization cycle, not otherwise specified, case rate |
| S4016 | Frozen in vitro fertilization cycle, case rate |
| S4017 | Incomplete cycle, treatment cancelled prior to stimulation, case rate |
| S4021 | In vitro fertilization procedure cancelled after aspiration, case rate |
| S4023 | Donor egg cycle, incomplete, case rate |
| S4025 | Donor services for in vitro fertilization (sperm or embryo), case rate |
| S4030 | Sperm procurement and cryopreservation services; initial visit |
| S4031 | Sperm procurement and cryopreservation services; subsequent visit |
| S4035 | Stimulated intrauterine insemination (IUI), case rate |
| S4018 | Frozen embryo transfer procedure cancelled before transfer, case rate |
| S4020 | In vitro fertilization procedure cancelled before aspiration, case rate |
| S4022 | Assisted oocyte fertilization, case rate |
| S4026 | Procurement of donor sperm from sperm bank |
| S4027 | Storage of previously frozen embryos |
| S4040 | Monitoring and storage of cryopreserved embryos, per 30 days |
| S4042 | Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle |
| 58322 | Artificial Insemination - Intrauterine |
| 58970 | Abdominal or endoscopic aspiration of eggs from ovaries |
| 58974 | Injection of embryo(s) into uterus |
| 89253 | Assisted embryo hatching, microtechniques (any method) |
| 89261 | Sperm Isolation |
| 89268 | Insemination of Oocytes |
| 89272 | Extended cultures of Oocytes (4-7 days). Embryo culture lab. |
| 89280 | ICSI - Assisted oocyte Fertilization, Microtechnique (Less than 10 oocytes) |
| 89281 | ICSI - Assisted oocyte Fertilization, Microtechnique (Greater than 10 oocytes) |
| 89337 | Cryopreservation; oocytes |
| 89342 | Storage, (per year); embryo(s) |
| 89346 | Storage (one year); oocytes |
| 89250 | Culture and fertilization of oocyte(s); with co-culture of embryos |
| 89251 | Culture of oocyte(s)/embryo(s), less than 4 days |
| 58321 | Artificial insemination; intra-cervical |
| 58976 | Gamete, zygote, or embryo intrafallopian transfer, any method |
| 89252 | Assisted oocyte fertilization, microtechnique (any method) |

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*\*Please note that all Progyny claims should be paid/processed at billed charges.*