Coding For Alpha-Fetoprotein Testing
My clinic is looking into implementing Alpha-Fetoprotein (AFP) testing. I understand there is currently no CPT code listed for this testing as it is not considered medically necessary-is that correct? Also, if there is currently no CPT coding, what code would be used? And lastly, if there is no CPT coding then we cannot bill insurance so can we bill patients?
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Coding Q&A
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Billing Physician vs Service Physician
What physician’s name must be on the treatment notes and who we are permitted to bill to insurance for:
Documentation for ultrasound coding 76830
Regarding billing code 76830: it “includes imaging of the uterus, endometrium, fallopian tubes, ovaries, and pelvic structures such as the bladder, as indicated.
Billing both partners for 99205 initial consultation
We discussed the ability to bill 99205 for an initial consultation on both the male and female partners if they both present for the consultation.
Oocyte cryopreservation
We code 89337 (cryopreservation of oocytes) for the entire oocyte preservation cycle, including monitoring visits.Coding Corner
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The Coding Corner Q & A is a list of previously submitted and answered questions from ASRM members about coding. Answers are available to ASRM Members only.
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Topic Resources
View more on the topic of insurance
Nation’s Leading Professional Group for Fertility Care Professionals Calls for Passage of Right to IVF Act
ASRM applauds Majority Leader Schumer’s decision to seek reconsideration of the Right to IVF Act.
View the Press Release
Billing Physician vs Service Physician
What physician’s name must be on the treatment notes and who we are permitted to bill to insurance for: View the Answer
ASRM announces support for HOPE with Fertility Services Act
The American Society for Reproductive Medicine is proud to endorse the HOPE with Fertility Services Act (HR 8821).
View the Press Release
ASRM Responds to Senate Vote on IVF Bill
ASRM is disappointed that a filibuster prevented the passage of the Right to IVF Act.
View the Press Release
ASRM Calls for Passage of Family Building Bill
It would increase access to IVF treatments for all Americans, including active-duty service members, veterans, and federal employees.
View the Press Release
Mandated states and egg retrieval
What name should you use to submit for reimbursement for the actual egg donor when there is benefit for the donor egg retrieval? View the Answer
Survey shows strong support for increased access to fertility treatments
A new public opinion poll reveals strong support for improved access to In Vitro Fertilization (IVF).
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Billing 58558 together with 58560
Can CPT codes 58558 and 58560 be billed together? Also, can 58560 be billed with place of service 11? View the Answer
Endometrioma
Surgery was performed under anesthesia for Aspiration of right hyrosalpinx fluid and right endometrioma. View the Answer
IVF coverage denied for Z31.83 diagnosis code
My wife and I have been seeking IVF treatment and coverage was added for infertility treatment (up to $25,000) but our insurer keeps denying it. View the Answer
Cycle coordination fees and 99499, S4042
I reviewed cycle coordination fees, but see that there is no specific code for cycle management. View the Answer
Reimbursement for cost of donor egg
My wife and I are going through a fertility treatment process, and we have purchased a donor egg out-of-pocket from a donor bank. View the Answer
Coding for Ovarian tissue cryopreservation, experimental or not?
For Cryopreservation; Reproductive Tissue Ovarian- 0058T code is not being recognized. Is there an updated one being used or a replacement of this code? View the Answer
Supervising provider for embryology billing
We typically bill our IVF Lab work under the rendering provider who performs the VOR. Who should be the supervising provider for embryology billing? View the Answer
Billing 58558 and 58560 together
Can CPT codes 58558 and 58560 be billed together? Also, can 58560 be billed with place of service 11? View the Answer
Total versus Free estradiol
Should patients with fertility issues be billing Estradiol Free (82681) instead of Estradiol Total (82670)? View the Answer
Unlisted Fertility Treatment CPT Code
Can you please refer me to an unlisted management CPT code for fertility treatment? View the Answer
Vitamin D Testing in Infertility Patients
We are being told that, as of this year, vitamin D level screening is not being covered by many insurers. View the Answer
Z Codes Vs. Procedure Codes For Fertility Preservation Counseling
I am trying to understand better when to use the procreative management code vs the fertility preservation counseling and procedure codes. View the Answer
Initial Visit for Infertility With No Mandated Coverage
What code would be appropriate for an initial visit for infertility? View the Answer
Non-REI Board Certified MD Performing REI Procedures
My boss has a few follow up questions about a non-REI board certified MD performing REI procedures. View the Answer
ICD-10 Code For Intrauterine Insemination (IUI) For Same-Sex Couple
Which ICD-10 code you recommend for IUI same gender couples? View the Answer
Flat Fee For Outside Monitoring
Can our office charge outside monitoring patients a flat fee to be seen? View the Answer
Global Billing Vs Billing Under Provider
For an IVF cycle (that is not being billed global to an insurance plan) is it appropriate to bill the charges under one “global” provider? View the Answer
Embryo Culture Denied As Experimental
We have received denials from insurance payers when billing CPT code 89251. View the Answer
Frozen Embryo Transport
What is the code for the cost of frozen embryo transport? View the Answer
Diagnosis Codes For Intrauterine Insemination (IUI)
I was reviewing your Coding Corner information to find a definitive diagnosis for IUI procedures. Which diagnosis is the most appropriate? View the Answer
Donor Egg-Retrieval On Recipient's Claim
Is the donor egg retrieval included on the bill to insurance with the first IVF treatment for the recipient? View the Answer
Billing at an Outside Clinic for Lab Services
One of my physicians uses an outside facility to perform the retrievals and transfers. View the Answer
Billing For Procedures Performed By Outside Physicians
Our physician tested positive for COVID-19, so another physician not associated with our office performed our egg retrievals and embryo transfers. View the Answer
Board Certified Vs. Non-Board Certified Billing
Is coding/billing any different when a non-board certified or non-REI provider submits for REI procedure? View the Answer
Coding For Alpha-Fetoprotein Testing
My clinic is looking into implementing Alpha-Fetoprotein (AFP) testing. I understand there is currently no CPT code listed for this testing. View the Answer
Billing For Cryopreservation Of Embryos Under The Male Partner
Can 89258 be billed under the male partner of a female patient? View the Answer
Coding For Long-Term Storage Of Embryos
We have recently been contacted by a payer stating we have a patient whose plan will cover long-term storage of her embryos. View the Answer
Claim Form for Donor Egg Retrieval
What bill form is used of IVF donor egg retrieval? View the Answer
Coding For Donor Egg Retrieval For Male Intended Parent
In coding a donor-egg retrieval to bill to insurance under the male intended parent, would it be appropriate to use the Z31.83? View the Answer
Male Infertility
A summary of common codes for Male Infertility compiled by the ASRM Coding Committee. View the Coding Summary
Mental-health Services During Assisted Reproduction
A summary of codes for Mental-health Services During Assisted Reproduction compiled by the ASRM Coding Committee. View the Coding Summary
PCOS
A summary of codes for PCOS as compiled by the ASRM Coding Committee. View the Coding Summary
Recurrent Pregnancy Loss (RPL)
Strategy for coding for a patient with RPL - codes compiled by the ASRM Coding Committee. View the Coding Summary
Laboratory Procedures during ART Cycles
A listing of codes, compiled for a fresh ART cycle, transfer, biopsy, cryopreservation of embryos and oocytes, storage, and thawing. View the Coding Summary
Embryo Transfer
A summary of Embryo Transfer codes collected by the ASRM Coding Committee View the Coding Summary
Endometriosis
A summary of common codes for Endometriosis compiled by the ASRM Coding Committee View the Coding Summary
Fibroids
A summary of codes to use with fibroids and myomas compiled by the ASRM Coding Committee View the Coding Summary
Fertility Preservation
A summary of codes for Fertility Preservation compiled by the ASRM Coding Committee. View the Coding Summary
Jan 2022: Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
At the September 2021 CPT Editorial Panel Meeting, a new Modifier was accepted to describe real-time telemedicine services. View the Letter
Feb 2021: CMS holds physicians harmless from Merit-based Incentive Payment System (MIPS) penalties amid COVID-19 Public Health Emergency
CMS announced it will hold physicians harmless from up to 9% MIPS penalties due to the significant disruptions of the COVID-19 public health emergency. View the Letter
Jan 2021: Coding for COVID-19 Vaccine Administration
AMA has published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations. View the Letter
