Illinois

Fertility Billing Services for Illinois IVF Practices

Illinois has one of the most comprehensive fertility insurance mandates in the country — 4 IVF retrievals and unlimited embryo transfers for qualifying fully-insured plans. EasyRCM helps Illinois fertility practices maximize mandate reimbursement, navigate BCBS Illinois and UHC claim requirements, and capture every billable cycle component.

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Illinois Fertility Mandate — Key Facts

Illinois Insurance Code §356m (the Illinois Fertility Mandate) requires group health plans with 25+ employees that are issued in Illinois to cover IVF. The mandate covers 4 egg retrievals per lifetime, unlimited embryo transfers, and all medically necessary procedures including ICSI, PGT, and sperm retrieval.

The Illinois mandate is one of the few state mandates that explicitly covers ICSI and PGT — meaning embryology lab charges (89250, 89258, 89290) and PGT-A/PGT-M biopsy are mandated services, not optional riders. This expands the billable surface significantly compared to states with narrower mandates.

Same-sex couples are covered under the Illinois mandate — infertility is defined to include the inability to conceive due to a partner's biological sex, not just clinical infertility. This significantly broadens the patient population for mandate billing and eliminates the 12-month unprotected intercourse requirement for same-sex couples.

Top Illinois Payer Considerations

BlueCross BlueShield of Illinois
Largest insurer in IL. Mandate claims processed through dedicated fertility unit. Auth required for each retrieval cycle — FET authorizations are separate from retrieval auths.
UnitedHealthcare IL
High Chicago-market presence among large employers. Fertility benefit carve-outs via Progyny are common in Chicago tech and finance. Verify before submitting to UHC.
Aetna IL
Processes IL mandate claims. ICSI (89280) and PGT claims require separate auth under Aetna — do not bundle with the IVF retrieval authorization.
Progyny
Strong Chicago market presence. Smart Cycle model — units must be reported correctly. Out-of-network billing requires pre-authorization LOA with Progyny.
Cigna IL
Mandate applies to fully-insured Cigna plans issued in IL. Self-insured Cigna plans (majority of large IL employers) are ERISA-governed and may exclude IVF.

What We Handle for Illinois Practices

IL mandate eligibility verification and cycle tracking
BCBS IL mandate authorization submissions
ICSI and PGT mandate billing (89280, 89290)
Same-sex couple mandate billing with Z31.7 coding
Retrieval cycle limit tracking (4 per lifetime)
Unlimited FET cycle claim processing
Progyny Smart Cycle unit reporting
Aetna and Cigna IL mandate appeal support
Monthly collections and mandate utilization reporting

Serving Illinois fertility practices — Chicago to Springfield

Our free audit reviews your IL mandate compliance, BCBS and UHC claim accuracy, and AR aging — at no cost.

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