Summary & Overview
HCPCS S4013: Complete GIFT Cycle, Gamete Intrafallopian Transfer
HCPCS Level II code S4013 denotes a complete cycle for gamete intrafallopian transfer (GIFT), an assisted reproductive technology involving placement of gametes into the fallopian tube. Nationally, this code matters for payers and providers because it encapsulates a bundled surgical and clinical episode of fertility care that can affect coverage determinations, benefit design, and claims processing for reproductive services. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what S4013 represents clinically, the typical sites where the service is delivered, and the national implications for billing and coverage. The publication includes benchmarking context where available, notes on payer coverage patterns, and policy developments relevant to bundled fertility procedures. It also summarizes clinical context for GIFT cycles, highlighting that this code covers a complete case rate rather than discrete component services.
Data not available in the input is clearly indicated where specific payer rates, associated taxonomies, ICD-10 diagnoses, and related codes would normally appear. The focus is on a national perspective to inform billing, coding, and policy stakeholders about the role of S4013 in fertility service reimbursement and administrative workflows.
Billing Code Overview
HCPCS Level II code S4013 represents a complete cycle, gamete intrafallopian transfer (GIFT), case rate. This code covers the comprehensive service for a full GIFT cycle, a form of assisted reproductive technology in which gametes are transferred into the fallopian tube to facilitate fertilization.
Service type: Assisted reproductive technology / surgical fertility service
Typical site of service: Hospital outpatient department or ambulatory surgical center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 34-year-old woman with primary infertility undergoes a complete cycle of gamete intrafallopian transfer (GIFT) billed with S4013. The clinical workflow begins with baseline evaluation by a reproductive endocrinologist, controlled ovarian hyperstimulation with serial monitoring of follicular development, transvaginal oocyte retrieval, and immediate mixing of retrieved oocytes with partner or donor sperm in a sterile environment. Under anesthesia in an ambulatory surgical center or hospital outpatient department, the oocyte-sperm mixture is transferred into the patient’s fallopian tube(s) via laparoscopy or a transcervical catheter depending on surgical approach. Post-procedure recovery and short-term follow-up assess for procedure tolerance, early pregnancy testing, and management of complications such as ovarian hyperstimulation syndrome or infection.
Typical site of service: Ambulatory surgical center (ASC) or hospital outpatient department.
Typical patient scenario: A couple with tubal patency sufficient for tubal transfer, failed intrauterine insemination cycles, and normal semen analysis or using donor sperm. The patient receives pre-procedure counseling, hormone stimulation, oocyte retrieval, insemination of oocytes with sperm, and immediate tubal transfer during the same treatment cycle, all included in the case-rate S4013 service.
Coding Specifications
- The following modifiers are most clinically relevant to a complete GIFT cycle billed with
S4013. Each modifier is CMS-standard and used according to clinical circumstance.
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