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    • Infertility precertification updates

     

    Precertification is required for certain infertility services, such as intrauterine insemination (IUI) and assisted reproduction techniques (ART), when a participating provider gives the service. Precertification includes a review of the member’s plan requirements for the use of infertility benefits and the medical necessity criteria in Aetna’s Clinical Policy Bulletin #0327, Infertility.   

     

    This notice describes how we’re changing the authorization of IUI and ART during the precertification process. This benefit adjudication applies to requests received on or after January 1, 2019. This policy does not allow for retrospective cycle definition changes.  

     

    Authorizations for IUI 

    Effective February 18, 2019: When approving precertification requests for IUI, we’ll authorize approvals up to the plan’s IUI cycle benefit maximum — generally six cycles per lifetime. For plans with unlimited cycle limits, we’ll authorize six cycles.      

     

    This applies to the following: 

    • Current Procedural Terminology code 58322 

    • Healthcare Common Procedure Coding System code S4035 

     

    Authorizations for ART  

    Effective January 1, 2019, ART cycle-count definitions are as described in the chart below.

     

     

    Procedure 

     

     

     

     

    Cycle count  

     

     

     

     

    One complete, fresh in vitro fertilization (IVF) cycle with transfer (egg retrieval, fertilization and transfer of embryo) 

     

     

     

     

    One full cycle 

     

     

     

     

    One fresh IVF cycle with attempted egg aspiration (with or without egg retrieval) but without transfer of embryo 

     

     

     

     

    One-half cycle  

     

     

     

     

    Fertilization of egg and transfer of embryo 

     

     

     

     

    One-half cycle 

     

     

     

     

    One cryopreserved (frozen) embryo transfer 

     

     

     

     

    One-half cycle  

     

     

     

     

    One complete GIFT cycle 

     

     

     

     

    One full cycle 

     

     

     

     

    One complete ZIFT cycle 

     

     

     

     

    One full cycle  

     

     

     

    You can also view these authorization changes on our provider website. After you log in, go to “Plan Central” and click “Aetna Claims Policy Information.” Then click “Policy Information” and go to “Benefit Guidance Statements.” Select the statement titled “Infertility.” 

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