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 |
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 |
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) |
