60 lines
3.3 KiB
Markdown
60 lines
3.3 KiB
Markdown
---
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type: reference
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category: treatment_codes
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person:
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date:
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provider: Progyny
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source: progyny_treatment_codes.pdf
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---
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# Progyny Fertility Exclusive Treatment Codes List
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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.*
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## Treatment Codes
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| Code | Description |
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|---|---|
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| S4016 | Frozen In Vitro Fertilization Cycle, Case Rate |
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| 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 |
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| S4037 | Cryopreserved embryo transfer, case rate |
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| S4013 | Complete cycle, gamete intrafallopian transfer (GIFT), case rate |
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| S4014 | Complete cycle, zygote intrafallopian transfer (ZIFT), case rate |
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| S4015 | Complete in vitro fertilization cycle, not otherwise specified, case rate |
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| S4016 | Frozen in vitro fertilization cycle, case rate |
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| S4017 | Incomplete cycle, treatment cancelled prior to stimulation, case rate |
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| S4021 | In vitro fertilization procedure cancelled after aspiration, case rate |
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| S4023 | Donor egg cycle, incomplete, case rate |
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| S4025 | Donor services for in vitro fertilization (sperm or embryo), case rate |
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| S4030 | Sperm procurement and cryopreservation services; initial visit |
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| S4031 | Sperm procurement and cryopreservation services; subsequent visit |
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| S4035 | Stimulated intrauterine insemination (IUI), case rate |
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| S4018 | Frozen embryo transfer procedure cancelled before transfer, case rate |
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| S4020 | In vitro fertilization procedure cancelled before aspiration, case rate |
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| S4022 | Assisted oocyte fertilization, case rate |
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| S4026 | Procurement of donor sperm from sperm bank |
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| S4027 | Storage of previously frozen embryos |
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| S4040 | Monitoring and storage of cryopreserved embryos, per 30 days |
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| S4042 | Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle |
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| 58322 | Artificial Insemination - Intrauterine |
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| 58970 | Abdominal or endoscopic aspiration of eggs from ovaries |
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| 58974 | Injection of embryo(s) into uterus |
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| 89253 | Assisted embryo hatching, microtechniques (any method) |
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| 89261 | Sperm Isolation |
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| 89268 | Insemination of Oocytes |
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| 89272 | Extended cultures of Oocytes (4-7 days). Embryo culture lab. |
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| 89280 | ICSI - Assisted oocyte Fertilization, Microtechnique (Less than 10 oocytes) |
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| 89281 | ICSI - Assisted oocyte Fertilization, Microtechnique (Greater than 10 oocytes) |
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| 89337 | Cryopreservation; oocytes |
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| 89342 | Storage, (per year); embryo(s) |
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| 89346 | Storage (one year); oocytes |
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| 89250 | Culture and fertilization of oocyte(s); with co-culture of embryos |
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| 89251 | Culture of oocyte(s)/embryo(s), less than 4 days |
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| 58321 | Artificial insemination; intra-cervical |
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| 58976 | Gamete, zygote, or embryo intrafallopian transfer, any method |
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| 89252 | Assisted oocyte fertilization, microtechnique (any method) |
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*\*Please note that all Progyny claims should be paid/processed at billed charges.*
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