3.3 KiB
3.3 KiB
type, category, person, date, provider, source
| type | category | person | date | provider | source |
|---|---|---|---|---|---|
| reference | treatment_codes | Progyny | progyny_treatment_codes.pdf |
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) |
*Please note that all Progyny claims should be paid/processed at billed charges.