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Posted By lana on 10-12-2006, 13:13:00 in Ob-Gyn
Can't think this morning. Does Medicare cover dx of infertility???


Comments (5)
Posted By Arlene on 10-20-2006, 20:48:00
Never have had them pay for anything related to infertility.....interesting.
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Posted By Arlene on 10-19-2006, 17:23:00
Medicare does not cover those things which are considered Not Medically Necessary.....that is infertility....not medically necessary they do not cover any infertility diagnosis or treatment....
Posted By lana on 10-19-2006, 17:12:00
I called Medicare and asked "Is diagnosis of infertility a covered benefit?"
I was told it would depend on "medical necessity". I asked what did that
mean. I don't see how simply infertility would ever be medically necessary.
They wouldn't say, just repeated - "depends on the medical necessary". I
took that to be a "No." (However, I, too, noticed some infertility related
CPTs with allowed amounts.) Makes no sense to me.........
Posted By Tricia on 10-19-2006, 15:46:00
Our practice does not participate w/Medicare, so I cannot give you a definitive yes or no answer, however, Medicare does have allowances for most infertility treatment CPT codes, including artificial insemination and aspiration of ova. The only code Medicare does not have an allowed amount for is the IVF procedure of embryo transfer (58974).

Because not all Medicare patients are elderly, I would think that they may cover the dx of infertility on a case-by-case basis. There are quite a few women on disability who are of child-bearing age. I can't see why they would have allowances for infertility related codes if they never paid on them.

Good luck!
Tricia L. Campbell, CPC
Supervisor of Billing Services
Fertility Centers of IL
Posted By Arlene on 10-12-2006, 14:20:00
not that i have ever seen
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