Practical Insights for
Fertility Billing Teams
Coding updates, denial patterns, payer rules, and revenue cycle strategies — specific to IVF and reproductive medicine practices.
Latest Articles
What Is Fertility Billing and Why Specialty Expertise Matters
Fertility billing is fundamentally different from general medical billing. Learn why IVF practices need a specialist — and what happens when they don't use one.
IVF CPT Codes: A Complete 2026 Guide for Billing Managers
A comprehensive reference for CPT codes used in IVF billing — oocyte retrieval, embryo transfer, cryopreservation, and more — with payer-specific notes.
FET Billing: Frozen Embryo Transfer Coding and Reimbursement
Everything you need to know about billing for frozen embryo transfer cycles — CPT codes, bundling rules, and how to avoid the most common FET denial reasons.
Why Fertility Practices Lose Revenue on IVF Monitoring Claims
IVF stimulation monitoring visits are among the most frequently underbilled or denied services in fertility billing. Here is what goes wrong and how to fix it.
IUI Billing Checklist: 6 Components Most Practices Miss
Most practices bill the IUI procedure code — but miss up to five other billable services in the same cycle. Here is the complete IUI billing checklist.
Using the Wrong Ultrasound Code: A Common and Costly Mistake in Fertility Billing
76817, 76830, 76831 — three ultrasound codes with very different payer rules. Using the wrong one can void your claim. Here is what each code covers and when to use it.
How Fertility Mandate States Differ: What Billers Need to Know
Not all state fertility insurance mandates are equal — some cover IVF, some only diagnostics, some have lifetime limits. Knowing the difference prevents billing to the wrong benefit.
Using the Wrong Diagnosis Code in IVF: Why It Causes Claim Denials
ICD-10 code selection in IVF billing is not a formality — the wrong diagnosis can trigger automatic denial, prior auth failure, or a medical necessity flag. Here is how to get it right.
Infertility Coverage: Monitoring Only vs. Monitoring and Procedure
Some plans cover monitoring but not the procedure. Others cover both. Billing without knowing the distinction can result in voided claims or unexpected patient balances.
Major Medical vs. Fertility Benefit Managers: How to Avoid Voided Claims
When a patient has both major medical and a fertility benefit manager, billing the wrong plan voids the claim. Here is how to navigate dual-benefit situations.
Prior Authorization in Fertility Billing: Getting It Right the First Time
Prior authorization errors in fertility billing do not just delay payment — they can void the claim entirely. Here is how to build a reliable auth workflow from the first patient contact.
Telehealth in Fertility Practices: Billing the 98xxx CPT Code Series Correctly
The 2025 CPT code book introduced an entirely new 98xxx telehealth E/M series. Here is what each code covers, how it replaces the pandemic-era approach, and what Medicare and commercial payers are actually accepting.
PGT Billing: Who Bills What and How to Avoid Lab Claim Conflicts
PGT billing involves the clinic, the embryology lab, and a third-party genetics lab — all with overlapping CPT codes. Here is how to coordinate billing and avoid duplicate claim conflicts.
FET vs. Fresh Transfer Billing: What's the Same, What's Different
FET and fresh transfer cycles share some billing codes and diverge sharply in others. Understanding the differences prevents authorization mismatches and coding errors.
ICD-10 Coding for PCOS Patients Undergoing ART
PCOS is the most common diagnosis in fertility practices — and one of the most frequently miscoded. Here is how to select and sequence ICD-10 codes correctly for PCOS patients undergoing ART.
Understanding Fertility Benefit Managers: Progyny, Maven, WINFertility, Kindbody
Fertility benefit managers have their own authorization systems, code requirements, and billing portals. Here is what your billing team needs to know about the four major FBMs.
PGT Billing: A Complete Guide to Preimplantation Genetic Testing Reimbursement
Preimplantation genetic testing involves the clinic, the embryology lab, and a third-party genetics lab — each with distinct CPT codes and billing responsibilities. This guide covers how to bill PGT-A and PGT-M correctly.
FET Billing and Coding: A Complete Reimbursement Guide
Frozen embryo transfer billing requires precise CPT code selection, cycle-level prior authorization, and an understanding of how FET differs from fresh transfer billing. This guide covers everything your billing team needs.
ASRM IVF CPT Code Recommendations: What Fertility Billers Need to Know
ASRM's Practice Committee publishes authoritative CPT guidance for IVF — but translating that guidance into clean claims requires knowing how payers interpret it. Here's what billing teams need to understand.
How ASRM's ART CPT Committee Recommendations Affect Your Practice's Revenue
ASRM's ART CPT Committee shapes the codes your practice bills every day. Understanding how that process works — and where payers lag behind — can protect your revenue when codes change.
ASRM PGT Billing: Coding 89290, 89291, and the Biopsy-to-Transfer Chain
ASRM guidance on PGT spans the embryo biopsy, the genetics lab analysis, and the subsequent FET cycle. Each step has distinct codes — and distinct authorization requirements. Here is how to bill the full chain correctly.
ASRM Egg Freezing Guidelines and the Billing Implications for Your Practice
ASRM's removal of the 'experimental' label from elective egg freezing changed what practices can bill — and what payers must cover. Here is how that guideline shift affects your billing workflows.
PGT-A Billing: CPT Codes, Authorization, and Denial Prevention
PGT-A billing spans embryo biopsy, genetics lab analysis, and a subsequent FET cycle — each with distinct codes and authorization requirements. Here is how to bill all three phases correctly.
PGT-M and PGT-SR Billing: Genetic Testing Code Selection
PGT-M and PGT-SR require distinct CPT codes, specialized authorization documentation, and genetics lab coordination that differs meaningfully from PGT-A. Here is what billing staff need to know.
Donor Egg Recipient Billing: What the Clinic Must Know
Billing for a donor egg recipient is not the same as billing a standard IVF cycle. The code set, ICD-10 selection, and authorization pathway all differ — and the most common errors are preventable.
Egg Freezing Billing: Fertility Preservation CPT Codes and Coverage
Elective egg freezing and oncofertility preservation are billed very differently — wrong diagnosis code selection leads to automatic denials. Here is the complete coding and coverage guide.
TESE and MESA Billing: CPT Codes, Lab Claims, and Auth Requirements
Surgical sperm retrieval billing spans urology procedure codes, andrology lab charges, and anesthesia — each with separate payer rules. Here is the complete TESE/MESA coding and claims reference.
Ovarian Reserve Testing Billing: AMH, AFC, and Day 3 Labs
AMH blood tests, Day 3 lab panels, and antral follicle count ultrasounds each carry distinct CPT codes, payer coverage rules, and denial risks. Here is the complete billing reference for ovarian reserve testing.
HSG Billing in Fertility Practices: CPT Codes and Denial Prevention
A complete guide to billing hysterosalpingography (HSG) in fertility practices, covering CPT 74740, ICD-10 selection, modifiers, benefit routing, and how to prevent the most common HSG claim denials.
ERA (Endometrial Receptivity Array) Billing: CPT Codes and Coverage
A complete billing guide for ERA testing in fertility practices — CPT code selection, ICD-10 mapping, payer coverage rules, and denial prevention strategies.
Hysteroscopy Billing for Fertility Patients: CPT Codes and Denials
A complete guide to hysteroscopy billing in fertility practices — CPT code selection from 58555 to 58561, ICD-10 diagnosis routing, prior authorization strategy, modifier rules, and denial prevention.
Cancelled IVF Cycle Billing: What to Charge and What to Write Off
When an IVF cycle is cancelled mid-stimulation or post-retrieval, billing decisions become complex. Learn which CPT codes are billable, what to write off, and how payers handle partial cycle claims.
OHSS Billing: When Ovarian Hyperstimulation Requires Separate Claims
Ovarian hyperstimulation syndrome generates billable services outside the IVF global period. Learn the CPT codes, ICD-10 sequencing, payer-specific rules, and documentation required to correctly bill every OHSS encounter.
Fertility Medication Billing: Gonal-F, Menopur, Follistim J-Codes
Gonadotropins and ART cycle support medications follow complex routing rules across medical and pharmacy benefits. This guide covers J-codes, NDC requirements, unit calculation, prior authorization, and payer-specific rules for billing fertility drugs correctly.
Progyny Smart Cycle Billing: A Complete Practice Guide
Progyny Smart Cycles reimburse fertility services differently from commercial insurance — one flat cycle bundle covers nearly all clinical services. This guide covers what is included, what bills separately, how to submit claims, and how to prevent the most common Progyny billing errors.
WINFertility Billing: Timely Filing, Authorization, and Network Rules
WINFertility manages fertility benefits for self-funded employer plans under its own authorization, network, and timely filing rules — separate from Aetna commercial. This guide covers how to bill WINFertility accounts correctly and avoid the most common claim errors.
How to Bill Carrot Fertility Patients: A Complete Practice Guide
Carrot Fertility operates as an employer-funded spending platform, not a traditional insurance payer. This guide explains the correct financial workflow, documentation requirements, and revenue cycle risks for practices treating Carrot members.
Medicare Billing for Fertility Services: Coverage Rules and Compliance
Medicare excludes most fertility treatments, but misapplying the infertility exclusion costs practices revenue on legitimately covered diagnostics. Here's exactly what Medicare pays, what it doesn't, and how to protect your practice.
TRICARE Fertility Billing for Military Families
TRICARE covers fertility diagnostics but excludes most treatments — with a critical NDAA exception for combat-injured service members that many practices overlook. Here is the complete billing guide.
Federal Employee FEHB Fertility Benefits Billing Guide
FEHB plans vary widely in fertility coverage—from full IVF benefits to diagnostic-only. This guide covers prior auth, CPT codes, BCBS FEP, GEHA, and the most common billing errors for federal employee patients.
Out-of-Network Fertility Billing: Patient Rights and Practice Strategy
Master OON fertility billing with single case agreements, UCR charge strategy, No Surprises Act compliance, and state balance billing law guidance for reproductive endocrinology practices.
Fertility Practice AR Recovery: Aging Buckets and Priority Strategies
A systematic framework for fertility billing AR management: how to segment claims by aging bucket, prioritize your work queue, and recover denied IVF claims before appeal windows close.
How to Write a Winning IVF Denial Appeal Letter
A step-by-step guide to writing IVF denial appeal letters that overturn denials: how to classify the denial type, source payer-specific medical necessity criteria, compile clinical documentation, and structure the letter for maximum impact.
Peer-to-Peer Review Requests for Fertility Medical Necessity
A complete guide to requesting, preparing for, and winning peer-to-peer reviews for IVF and ART medical necessity denials — including payer-specific contact methods, P2P timing windows, and the clinical arguments that produce the highest overturn rates.
Medical Necessity Criteria for IVF: What Payers Actually Require
A payer-by-payer breakdown of the exact medical necessity criteria commercial insurers use to approve or deny IVF authorizations — including diagnosis codes, step-therapy rules, bypass diagnoses, and documentation standards.
Aetna Fertility Billing: Coverage Rules and Authorization Tips
Navigate Aetna's fertility Clinical Policy Bulletins, secure prior authorization for IVF and FET, and prevent the most common Aetna denial reasons across fully insured and self-funded plans.
Cigna Fertility Billing: Auth Requirements and Common Denial Reasons
A complete guide to Cigna fertility billing covering prior authorization requirements, step-therapy rules, CPT code lists, common denial reasons, and appeal strategies for fertility practices.
United Healthcare Fertility Billing: Global Period and Itemized Claims
UHC applies global period billing to some fertility plans and itemized billing to others — and billing the wrong model voids the claim. This guide covers how to identify which model applies, how to authorize correctly, and how to prevent the most common UHC fertility denials.
Blue Cross Blue Shield Fertility Billing by State Plan
BCBS is not one payer — it is 35+ independent plans with different fertility coverage rules, mandate applicability, and authorization pathways. This guide breaks down how to bill BCBS fertility services correctly by plan type.
California SB-729 Fertility Mandate: Billing Implications for IVF Clinics
SB-729 extended IVF coverage to California-regulated large group plans beginning January 1, 2024 — but only fully insured plans with 100+ employees must comply. This guide covers which plans qualify, how infertility is defined for same-sex and single patients, and how to structure claims to avoid mandate-specific denials.
Illinois Fertility Insurance Mandate: What Clinics Must Bill
A complete billing reference for the Illinois fertility insurance mandate under 215 ILCS 5/356m — covered services, CPT codes, carrier-specific prior authorization pathways, and denial prevention strategies.
New York Fertility Mandate Billing: Unlimited IVF Coverage Rules
A complete billing reference for New York's fertility insurance mandate under NY Insurance Law §3221(k)(6) — unlimited IVF cycles, CPT codes, carrier prior authorization pathways, and denial prevention for NY practices.
New Jersey Fertility Mandate Billing: What Changed and What to Know
New Jersey's 2021 mandate expansion made IVF a required covered service for the first time. Learn the 4-retrieval cap, carrier PA requirements, FET billing rules, and common denial patterns for NJ fully insured plans.
Endometrial Biopsy Billing in Fertility Practices
A complete billing guide for endometrial biopsy in fertility practices — covering CPT 58100, ICD-10 selection by indication, benefit routing, pathology billing, and denial prevention.
Sperm Banking and Storage Billing in Fertility Practices
A complete billing guide for sperm cryopreservation, annual storage, and thawing procedures — including CPT codes, ICD-10 selection, and oncofertility coverage rules.
Gestational Carrier Billing: Who Bills What
Gestational carrier cycles generate two parallel billing tracks across two patients and potentially two insurance policies. Learn which CPT codes belong on which claim, how to handle coverage for both parties, and how to prevent the most common GC billing denials.
Recurrent Pregnancy Loss Workup Billing: CPT and ICD-10 Guide
A complete coding and billing reference for the RPL diagnostic workup — covering antiphospholipid panels, thrombophilia testing, parental karyotyping, uterine evaluation, and payer coverage rules.
Mock Transfer Billing: When and How to Charge
A complete billing reference for mock embryo transfer — covering CPT codes, ICD-10 selection, prior authorization timing, modifier use, and the documentation requirements that protect your claims from denial.
Laparoscopy Billing for Infertility Diagnosis and Treatment
A complete CPT coding and billing reference for diagnostic and operative laparoscopy in fertility practice — covering code selection, ICD-10 mapping, prior authorization strategy, modifier use, and denial resolution.
KPIs for Fertility Billing Performance: What to Track Monthly
A complete framework of fertility-specific billing KPIs — Days in AR, denial rate, net collection rate, prior auth metrics, and patient balance benchmarks — with industry targets and monthly review checklists.
How to Audit Your Fertility Billing Internally
A step-by-step guide to conducting an internal fertility billing audit — covering charge capture, coding accuracy, denial patterns, and AR integrity to protect your practice revenue.
Revenue Cycle Benchmarks for Fertility Practices 2026
The 2026 performance benchmarks every fertility billing team should track — from net collection rate and Days in AR to denial rates and appeal overturn rates, with fertility-specific context.
Semen Analysis Billing: Diagnostic vs. Therapeutic Code Selection
A complete guide to CPT codes 89300–89331, sperm processing codes 89261 and 89264, ICD-10 pairing for male factor infertility, and the bundling rules that determine when semen analysis codes pay separately.
How to Bill for Fertility Counseling and Psychological Services
Fertility counseling is one of the most underbilled service categories in reproductive medicine. Learn CPT codes, ICD-10 pairing, benefit routing, and payer-specific rules for mental health services in a fertility practice.
Split Billing Between Clinic and Embryology Lab
When a fertility clinic and its embryology lab operate under separate tax IDs, a single IVF cycle generates two distinct claim streams. Learn exactly which CPT codes go where, how payers adjudicate split claims, and how to avoid the most costly billing errors in shared-entity ART billing.
Correct Use of Modifier 59 in Fertility Billing
Modifier 59 is misused more often than almost any other billing modifier in ART practices. Learn which NCCI edits affect fertility CPT codes, when modifier 59 applies, and how to document distinct procedural services to survive payer audits.
How Prior Auth Expiration Causes IVF Claim Denials
Authorization expiration is one of the most preventable — and least recoverable — denial categories in IVF billing. Learn how payer auth windows interact with IVF cycle timelines, and build the workflows that stop mid-cycle expirations before they happen.
Billing for Fertility Genetic Counseling Visits
Genetic counseling is a routine part of fertility care that many practices leave unbilled or misbilled. Learn CPT 96040, incident-to rules, correct ICD-10 code selection, and payer-specific coverage policies for this distinct revenue category.
IVF Lab Billing Under a Separate Tax ID: A Complete Guide
When your embryology lab operates under a different EIN than the clinic, every CPT code, prior auth, and claim submission changes. Here is how to get it right.
Luteal Phase Support Billing: Progesterone Injections and Patches
How to correctly bill J2675, CPT 96372, and J3490 for progesterone injections and luteal phase support medications in IVF and FET cycles — including payer rules and compliance traps.
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