Fertility Billing Services for New York IVF Practices
New York has one of the strongest fertility insurance mandates in the country — three IVF cycles per lifetime for fully-insured plans — but only if claims are coded and submitted correctly. EasyRCM ensures New York fertility practices capture every mandated benefit while navigating Empire BlueCross, UnitedHealthcare NY, and Progyny's dense NYC footprint.
New York Fertility Mandate — Key Facts
New York Insurance Law §3221 requires fully-insured group health plans to cover three cycles of IVF (plus unlimited IUI cycles) for members who meet ASRM medical criteria for infertility. The mandate applies to group plans issued in New York — self-insured (ERISA) plans are exempt.
The NY mandate requires a documented infertility diagnosis (N97.x for female, N46.x for male factor) and at least 12 months of unprotected intercourse without conception (or 6 months for patients over 35). Prior authorization is mandatory and the authorization must reference the mandate-required medical necessity criteria.
FET cycles are covered under the NY mandate. PGT (preimplantation genetic testing) is not mandated but may be covered under separate rider depending on the plan. Egg freezing for elective fertility preservation is not mandated unless there is a medical indication (e.g., oncofertility).
Top New York Payer Considerations
What We Handle for New York Practices
Serving New York fertility practices — NYC to Buffalo
Our free audit reviews your NY mandate compliance, payer routing accuracy, and AR aging — at no cost and no obligation.
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