Preconceptional Sex Selection Techniques
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This policy governs Aetna's coverage stance on preconceptional sex selection techniques (sperm-sorting and related procedures) and applies to members whose benefits are administered by Aetna and providers performing these services.
No material clinical or coverage changes in this revision.
Coverage Criteria
Medically Necessary Indication
Covered when ALL of the following are met
Example condition provided in policy.
Aetna considers assisted reproductive techniques such as in‑vitro fertilization (IVF) or intra‑cytoplasmic sperm injection (ICSI) not to be treatment of disease when the sole indication is sex selection and the procedure is not intended to prevent the birth of a child with a seriously handicapping X‑linked genetic defect. Providers should verify member plan benefits for any related infertility services, as coverage for post‑sperm sorting procedures (for example, intra‑uterine insemination, IVF, or gamete intrafallopian transfer) may be limited by the member’s specific plan or state mandate.
Use of assisted reproductive techniques solely for nonmedical sex selection purposes (for example, family balancing or other personal, social, or cultural reasons) is not considered treatment of disease and is excluded from medical necessity coverage. Requests for sex selection that are not intended to prevent transmission of a serious X‑linked disorder are not supported under this policy.
Related Procedure and Billing Codes
| 58321 | Artificial insemination; intra-cervical. |
| 58322 | Artificial insemination; intra-uterine. |
| 58974 | Embryo transfer, intrauterine. |
| 58976 | Gamete, zygote, or embryo intrafallopian transfer, any method. |
| 88182 | Flow cytometry, cell cycle or DNA analysis. |
| 88184 | Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker. |
| 88185 | Each additional marker (List separately in addition to code for first marker). |
| 88187 | Flow cytometry, interpretation; 2 to 8 markers. |
| 88188 | 9 to 15 markers. |
| 88189 | 16 or more markers. |
Provider Actions and Documentation Requirements
Prior Authorization May Be Required
Preconceptional sex selection techniques and related services may require prior authorization when coverage is sought under medical benefits.
- Applies to sperm-sorting and other preconceptional procedures described in this policy.
- Check member's benefit plan for coverage of assisted reproductive technologies (IVF, ICSI) which may be governed by state mandates or plan-specific limits.
Required Clinical Indication and Follow‑Up
Documentation must demonstrate the clinical indication and that the request is intended to prevent the conception and birth of a male child to a woman known to be heterozygous for a seriously handicapping X-linked condition (for example, Lesch‑Nyhan disease).
- Genetic counseling and confirmation of carrier status should be included in the record (eg, medical genetics visit, genetic test results).
- When sperm sorting is used, offer invasive prenatal diagnostic procedures as appropriate to confirm fetal sex when medically indicated.
Medical Necessity Limitation — Non‑qualifying Indications Are Not Covered
Requests for preconceptional sex selection that are for personal, social, cultural, or family‑balancing reasons — and not to prevent the conception and birth of an affected male child as described above — are not medically necessary and will be denied.
- Provider documentation indicating non‑medical reasons for the request may result in denial.
- Assisted reproductive techniques performed solely for sex selection without a qualifying medical indication are not considered treatment of disease.
Provider Billing and Coverage Considerations
Render provider‑impact highlights from source documentation: ensure that coding for related procedures (eg, sperm isolation, flow cytometry, insemination, IVF/embryo transfer, genetic counseling) accurately reflects the services performed and that benefit coverage for downstream infertility services may be limited by the member's plan.
Background
Primary (pre‑fertilization) sex selection involves enrichment of X‑ or Y‑bearing spermatozoa prior to conception using sperm‑sorting methods such as filtration or flow cytometry. Reported enrichment of sorted samples can be as high as 75%, but enrichment does not guarantee fetal sex. These techniques have been proposed to reduce transmission risk of serious sex‑linked genetic disorders; when used for that indication, invasive prenatal diagnostic testing should be offered when medically indicated to confirm fetal sex.
Definitions
Revision History
Policy became effective (policy inception).
Policy last reviewed on this date.
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