Fertility Billing Resources
Guides, references, and tools built for fertility billing teams, practice managers, and anyone navigating IVF insurance coverage.
What's in this library, and how to use it
Short answer: this library is organized into three tiers — long-form guides for topics that need real explanation, quick-reference tools for lookups you do repeatedly, and category references (payer, state, CPT) for data that changes by clinic, geography, or code.
Every guide targets a specific decision fertility billing teams actually make: whether to appeal a denial or write it off, whether to run billing in-house or outsource it, how to bill under a specific state mandate, and how to interpret a specific payer's IVF policy. Nothing here is generic fertility overview content — the audience is the person who runs the claim.
In-Depth Guides
Comprehensive coverage of the most complex topics in fertility billing.
Does Insurance Cover IVF?
Federal law, state mandates, ERISA self-funded plans, and a 16-state coverage table. Everything you need to verify IVF benefits accurately.
Read guide →IVF Denial Appeal Guide
The 5 most common IVF denial codes (CO-4, CO-11, CO-15, CO-50, CO-197) with required documentation, sample appeal language, and ASRM citations.
Read guide →Fertility Billing Outsourcing Guide
Full in-house vs. outsourced cost comparison, ROI calculation, 10 signs to outsource, and a 12-week transition timeline.
Read guide →ASRM Guidelines Hub
Key ASRM Practice Committee Opinions organized by clinical topic — IVF indications, PGT, donor cycles, and more. Essential for prior auth appeals.
Read guide →Where to start based on your role
- Fertility billing manager or biller — begin with the IVF Denial Appeal Guide. If a claim is stuck, the five denial codes it covers (CO-4, CO-11, CO-15, CO-50, CO-197) resolve the majority of what actually blocks fertility payment. Then bookmark the Authorization CPT Lookup and the payer billing guides for daily use.
- Practice manager or operations lead — start with the Fertility Billing Outsourcing Guide for the in-house vs. outsourced cost calculation, then use Does Insurance Cover IVF? and the state mandate references to align patient-facing benefit conversations with the actual coverage landscape.
- RCM director new to fertility — read Does Insurance Cover IVF? first for the federal / state mandate / employer plan stack, then the ASRM Guidelines Hub for the clinical criteria payers cite in denials, then the CPT code reference to internalize the ART code set.
- Patient or advocate researching coverage — Does Insurance Cover IVF? covers federal law, the mandate states, and how ERISA self-funded plans can opt out of state coverage requirements. Follow with the state mandate page for your specific state.
Tools & Quick References
Lookup tools and reference guides for day-to-day fertility billing work.
IVF Auth Decision Engine (v2)
Payer-aware wizard — answer guided questions to get CPT codes, S-codes, and prior auth guidance for your exact IVF, FET, IUI, or ART scenario.
Authorization CPT Code Lookup
Look up which CPT codes and S-codes require prior authorization for IVF, FET, IUI, and ancillary services — by clinical scenario.
ICD-10 Fertility Diagnosis Lookup
Search fertility ICD-10 codes — infertility, PCOS, male factor, uterine conditions, and more.
IVF CPT Code Reference
Complete reference for ART CPT codes — egg retrieval, embryo transfer, IUI, ICSI, cryopreservation, and lab procedures.
State IVF Mandate Reference
Billing guides for all 21 mandate states — coverage scope, cycle limits, payer-specific requirements, and billing tips.
Payer Billing Guides
UHC, Anthem, Cigna, Aetna, and BCBS fertility billing — auth requirements, denial patterns, and payer-specific tips.
How this library is organized
Guides answer decisions. Each in-depth guide targets one recurring question — appeal or write off, outsource or hire, verify or estimate — and gives a defensible answer with the criteria to reach it.
Tools return lookups. The Auth CPT Lookup, ICD-10 fertility diagnosis lookup, and IVF auth decision engine are designed for the 30-second questions that come up during eligibility work or claim scrub — “does this code need auth on this payer for this scenario?” — not for reading end-to-end.
Category references cover data that varies. The payer guides, the state mandate pages, and the CPT code pages are the reference material that changes by clinic — you dip into the one that matches the payer, state, or code on the claim in front of you rather than reading the set through.
For workflow and denial patterns published in shorter form — a specific ultrasound coding pitfall, an FBM secondary-billing walkthrough, a monitoring-vs-procedure ICD-10 pairing — see the fertility billing blog.
Fertility Billing Blog
CPT coding guides, denial management tips, payer policy updates, and practice management insights — published regularly by the EasyRCM billing team.
Questions About Your Practice's Billing?
EasyRCM handles fertility billing exclusively — we know the codes, the payers, and the mandates. Get a free review of your billing operations.
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