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CPT 58970: Transvaginal Oocyte Retrieval by Needle Aspiration
CPT code 58970 designates oocyte retrieval by transvaginal needle aspiration, a core procedure in in vitro fertilization (IVF) and other assisted reproductive technologies. It involves multiple ovarian punctures to aspirate eggs through a needle introduced usually via the vaginal wall and is a critical step in achieving laboratory fertilization. Nationally, this code represents a high-resource, procedure-driven service with implications for clinical workflow, facility utilization, and coverage policy for infertility care.
Key payers included in scope are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical procedure and typical sites of service, the common diagnostic contexts that justify use, and the billing relationships to closely related laboratory and embryo-transfer codes. The publication summarizes payer coverage patterns, common modifiers used with the code, and how 58970 interacts with adjacent reproductive services such as oocyte processing and embryo transfer.
This resource is intended for revenue cycle professionals, practice managers, and clinical leaders seeking a national-level briefing on coding and billing context for oocyte retrieval. It covers clinical context, typical billing pathways, links to related procedure codes used in assisted fertilization workflows, and the diagnoses that commonly accompany claims for 58970.
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Billing Code Overview
CPT code 58970 describes a transvaginal, needle-based procedure in which the provider creates multiple punctures in an ovary to retrieve oocytes for laboratory fertilization. This procedure is performed as part of assisted reproductive techniques and involves percutaneous access to ovarian follicles, typically via the vaginal wall under ultrasound guidance.
Service Type: Oocyte retrieval for assisted reproductive technology
Typical Site of Service: Hospital outpatient or ambulatory surgical center (procedure room) or fertility clinic procedure suite
National Reimbursement Benchmarks
Commercial averages sit markedly above Medicare: Blue Cross Blue Shield’s mean of $568.90 and BUCA’s mean of $455.60 compare with Medicare’s mean of $242.30, indicating commercial payers on average reimburse roughly two times Medicare for CPT 58970. Blue Cross Blue Shield reaches a $1,499.00 maximum while UnitedHealth Group and Cigna also show substantially higher mean levels at $377.30 and $366.80 respectively, underscoring a split between commercial and government reimbursement baselines.
Dispersion analysis (P75 minus P25) highlights where rates cluster or spread: Blue Cross Blue Shield’s interquartile spread is $314.70, BUCA’s is $250.10, UnitedHealth Group’s is $241.10, Cigna’s is $216.60, and Aetna’s is $178.00. This makes Aetna the tightest payer distribution and Blue Cross Blue Shield the widest, with BUCA and UnitedHealth Group showing moderate dispersion.