Surgical — IVF

CPT 58974 — Embryo Transfer — Fresh

Embryo transfer into the uterus using a fresh (never cryopreserved) embryo from the same stimulation cycle. This code applies when the embryo was cultured from oocytes retrieved in the current cycle and transferred without freezing.

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What CPT 58974 Covers and When to Bill It

CPT 58974 describes the transfer of embryo(s) into the uterus during a fresh IVF cycle — specifically, transcervical transfer of one or more embryos created from oocytes retrieved in the current stimulation cycle and never cryopreserved. The transfer is typically performed on Day 3 (cleavage stage) or Day 5-6 (blastocyst stage). The defining characteristic of 58974 is freshness: the embryo was never frozen before transfer.

58974 is one of the most frequently miscoded IVF procedures. It is incorrectly applied when a patient undergoes a frozen embryo transfer (FET) cycle. If an embryo was ever cryopreserved — even briefly — the transfer is reported with 58976, not 58974. Payers cross-reference laboratory reports and can detect cryopreservation dates during audit. Using 58974 when 58976 is correct results in denial or recoupment.

Fresh vs. Frozen Transfer: Choosing 58974 or 58976

Scenario	Correct Code	Explanation
Blastocysts transferred Day 5 (same cycle as retrieval)	58974	Embryos never frozen — fresh cycle.
Freeze-all cycle — transfer in next cycle	58976	Embryos were cryopreserved before transfer.
Fresh transfer cancelled — all embryos frozen	89258 only	Transfer did not occur; bill cryopreservation.
Donor egg cycle, fresh transfer same cycle	58974	Same-cycle fresh transfer regardless of egg source.
PGT cycle — embryos frozen pending results	58976 (at FET)	Biopsy protocol requires freezing; FET code at transfer.

Authorization for Fresh Embryo Transfer

Prior authorization for a fresh IVF cycle typically covers both egg retrieval (58970) and embryo transfer (58974) within the same authorization. However, if the transfer must be postponed past the authorization window due to OHSS risk, elevated progesterone, or endometrial factors, contact the payer immediately to extend or modify the authorization. Do not proceed with transfer on an expired authorization.

S4015 is the S code that corresponds to a fresh IVF cycle with embryo transfer. Submit alongside 58974 for mandate-state payers that require S code tracking.
For freeze-all cycles: bill 89258 (cryopreservation) for the current cycle. The subsequent FET will require a separate authorization and will be billed with 58976.
If the number of embryos transferred changes from what was stated in the auth request, document the clinical rationale — payers may audit transfers of more embryos than planned.

Revenue Alert

Freeze-all cycles are increasingly common due to PGT protocols and OHSS risk management. When a cycle converts from fresh to freeze-all after retrieval, bill 89258 in the current cycle and ensure the billing team is informed that the subsequent FET requires a new authorization and will use 58976 — not 58974.

Documentation Requirements for 58974

Prior authorization confirming transfer coverage within the active date range
Transfer procedure note: catheter type, technique, number of embryos transferred, and embryo quality grade
Embryology lab report confirming culture dates and that embryos were never cryopreserved
ICD-10 infertility diagnosis code consistent with authorization
Anesthesia documentation if conscious sedation was administered

Billing Notes

Do NOT use 58974 for frozen embryo transfers — use 58976 for FET. This is one of the most common IVF coding errors. Payers will deny 58974 when documentation shows a prior cryopreservation date.

Diagnosis Codes

N97.0–N97.9 (infertility by etiology), Z31.61 (ART encounter)

Common Denial Reasons

Used for frozen embryo transfer (should be 58976)
Authorization approved for fresh cycle but patient delayed transfer
Missing documentation of embryo origin date

Payer Notes

S4015 is the S code for fresh IVF cycle with embryo transfer for mandate payers. Confirm authorization covers the cycle start date, not just the retrieval date.