Currentjohns_hopkins_health_plansPolicy CMS23.07

Infertility Treatment and Fertility Preservation

Customize your policy alerts

Sign up for johns_hopkins_health_plans Policy CMS23.07 alerts

Get alerted when Policy CMS23.07 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Defines medical necessity criteria, covered services, limitations, and investigational exclusions for infertility evaluation, treatment, and fertility preservation across Johns Hopkins Health Plans lines of business where member benefits provide coverage.

Policy Summary

Payerjohns_hopkins_health_plans

PolicyInfertility Treatment and Fertility Preservation

Policy CodePolicy CMS23.07

Change TypeNo material change

Effective DateOct 1, 2025

Last ReviewOct 1, 2025

Next Review DateN/A

Key ActionVerify plan-specific coverage and prior authorization requirements and ensure services meet JHHP medical necessity criteria before providing or billing infertility or fertility preservation services.

SourceLink

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

Currentjohns_hopkins_health_plansPolicy CMS23.07

Infertility Treatment and Fertility Preservation

Customize your policy alerts

Sign up for johns_hopkins_health_plans Policy CMS23.07 alerts

Get alerted when Policy CMS23.07 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

Payerjohns_hopkins_health_plans

PolicyInfertility Treatment and Fertility Preservation

Policy CodePolicy CMS23.07

Change TypeNo material change

Effective DateOct 1, 2025

Last ReviewOct 1, 2025

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3max retrieval cycles (when covered)

12 monthsstorage approval limit (EHP when allowed)

12m / 6minfertility definition timing

Numerousservices listed investigational

15document pages

Coverage Criteria and Medical Necessity

General medical necessity and covered services

Covered when ALL of the following are met and the member's plan provides the benefit:

Member benefit: Member's specific plan must provide coverage for the infertility or fertility preservation service

Verify plan-specific documents (SPDs, COMAR, TRICARE, Medicare guidance) as coverage varies by line of business.

Infertility definition met: Member meets JHHP definition of infertility (duration criteria or qualifying diagnosis/recurrent pregnancy loss/gender-affirming related infertility)

See Definitions; durations: <35 years = 12 months; ≥35 years = 6 months.

Appropriate diagnostic/treatment sequence: Sequence of diagnostic and treatment services follows a logical and cost-effective approach (e.g., IUI before IVF when feasible; consider frozen embryo transfer prior to a new fresh IVF cycle)

Facilities performing ART must conform to ASRM standards.

Covered services list: Includes IUI/AI; ART (IVF fresh and FET); sperm retrieval procedures (e.g., TESE); ICSI; cryopreservation/freezing, storage, thawing of sperm, mature oocytes, ovarian cortex, and embryos; reimplantation of ovarian cortex

Subject to plan-specific limitations (e.g., storage duration for EHP).

Fertility preservation specific criteria

Covered when ALL of the following are met and benefits exist under the member's contract:

Indication: Fertility preservation is prior to gonadotoxic therapies or surgery (e.g., chemotherapy, radiation, gonadal surgery), for treatment of disease, or for gender-affirming surgery

Applies to PPMCO & EHP when benefits provided.

Allowed procedures and limits: Ovarian stimulation and oocyte retrieval (maximum of 3 cycles); sperm retrieval; ovarian cortex retrieval; cryopreservation/freezing and thawing of sperm, mature oocytes, ovarian cortex and embryos; storage of frozen sperm, oocytes, ovarian cortex, or embryos

EHP plans may approve up to 12 months storage when plan benefit allows.

Not Covered / Investigational Services

The policy lists specific procedures and tests considered investigational or not covered.

Listed investigational/not covered procedures: Leukocyte immunization; microdissection of the zona or sperm microinjection; co-culture of oocytes/embryos; in vitro maturation of oocytes; growth hormone for infertility; IVIG; intravenous fat emulsions; uterine and endometrial receptivity testing (e.g., Endometrial receptivity analysis like Igenomix; uterine receptivity tests for ß3 such as E-tegrity); uterine transplantation; laser-assisted necrotic blastomere removal of cryopreserved embryos; cryopreservation/freezing, thawing, or storage of immature oocytes or testicular tissue; reimplantation of cryopreserved testicular tissue; the following sperm function tests: acrosome reaction test; comet assay; computer-assisted sperm analysis (CASA); hemizona assay; hyaluronan binding assay; hypososmotic swelling test; in vitro testing of sperm penetration; reactive oxygen species (ROS) test; sperm chromatin assay; sperm DNA condensation test; sperm DNA fragmentation assay; sperm nucleus maturation; Path SpermQT™ Epigenetic Sperm Quality Test; and any infertility service determined to be investigational or experimental.

Exact items listed as experimental/investigational per policy.

The policy excludes infertility treatment related to prior voluntary sterilization and its reversal: specifically, services are not covered when infertility is caused by a previous voluntary sterilization procedure or when the service is a reversal of voluntary sterilization performed for the purpose of infertility treatment. The policy also lists other explicit exclusions including infertility treatment for a post‑menopausal woman, services associated with a surrogate or gestational carrier, infertility services for a member who is not infertile (for example, ovarian stimulation for an egg donor except where noted), and over‑the‑counter supplies such as ovulation or pregnancy test kits. These exclusions apply unless the member's specific plan provides otherwise.

JHHP identifies multiple procedures and sperm function tests as experimental, investigational, or otherwise not covered. The listed items include leukocyte immunization; microdissection of the zona or sperm microinjection; co‑culture of oocytes/embryos; in vitro maturation (IVM) of oocytes; growth hormone for infertility; IVIG and intravenous fat emulsions for infertility; uterine and endometrial receptivity testing (e.g., Endometrial Receptivity Analysis/Igenomix and ß3 tests such as E‑tegrity); uterine transplantation; laser‑assisted necrotic blastomere removal of cryopreserved embryos; and an enumerated set of sperm function assays (acrosome reaction, comet assay, CASA, hemizona assay, hyaluronan binding, hypososmotic swelling test, in vitro sperm penetration tests, ROS test, sperm chromatin and DNA condensation/fragmentation assays, sperm nucleus maturation). The policy also names the Path SpermQT™ Epigenetic Sperm Quality Test and states that any infertility service determined to be investigational or experimental is considered not covered.

HCPCS and S‑codes shown in the policy are provided for informational purposes only. The document explicitly notes: HCPCS CODES ARE FOR INFORMATIONAL PURPOSES ONLY, and lists example HCPCS/S codes (e.g., G0027, S3655, S4011–S4042) to assist with claim alignment and benefit review.

Within the excerpted document there are no additional broad exclusions beyond those explicitly listed in the policy text. Where exclusions exist, they are stated directly in the policy; in the remainder of the excerpt no other blanket exclusions are provided.

The policy explicitly identifies certain investigational services that are not covered, including cryopreservation, freezing, thawing, or storage of immature oocytes or testicular tissue, and reimplantation of cryopreserved testicular tissue. These items are categorized as experimental/investigational and therefore not covered unless the member's contract provides otherwise.

JHHP treats services designated as experimental or investigational as not medically necessary and therefore not covered when benefits are not provided under the member's contract. The policy states that any infertility service determined to be investigational or experimental falls into this category.

The provided excerpt does not contain additional explicit statements using the exact phrase 'not medically necessary' beyond the items already categorized as experimental/investigational. Practically, items listed as investigational are treated as not covered unless the member's plan specifies otherwise.

Procedure, HCPCS and Diagnosis Codes

Informational CPT codes listedCPT

54500	Biopsy of testis, needle (separate procedure)
54505	Biopsy of testis, incisional (separate procedure)
55400	Vasovasostomy, vasovasorrhaphy
55870	Electroejaculation
58321	Artificial insemination; intra-cervical
58322	Artificial insemination; intra-uterine
58323	Sperm washing for artificial insemination
58345	Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography

Covered CPT Codes (partial list from document)CPTCovered

58350	Chromotubation of oviduct, including materials.
58672	Laparoscopy, surgical; with fimbrioplasty.
58673	Laparoscopy, surgical; with salpingostomy (salpingoneostomy).
58750	Tubotubal anastomosis.
58825	Transposition, ovary(s).
58970	Follicle puncture for oocyte retrieval, any method.
58974	Embryo transfer, intrauterine.
74440	Vasography, vesiculography, or epididymography, radiological supervision and interpretation.
74740	Hysterosalpingography, radiological supervision and interpretation.
76831	Saline infusion sonohysterography (SIS), including color flow Doppler, when performed.

1–10 of 24

1/3

Covered CPT Codes (continued)CPTCovered

89260	Sperm isolation; simple prep (eg, sperm wash and swim-up) for insemination or diagnosis with semen analysis.
89261	Sperm isolation; complex prep (eg, Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis.
89264	Sperm identification from testis tissue, fresh or cryopreserved.
89268	Insemination of oocytes.
89272	Extended culture of oocyte(s)/embryo(s), 4-7 days.
89280	Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes.
89281	Assisted oocyte fertilization, microtechnique; greater than 10 oocytes.
89290	Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); less than or equal to 5 embryos.
89291	Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); greater than 5 embryos.
89300	Semen analysis; presence and/or motility of sperm including Huhner test (post coital).

1–10 of 27

1/3

HCPCS Codes and S-codes (informational)HCPCS

G0027	Semen analysis; presence and/or motility of sperm excluding Huhner.
S3655	Antisperm antibodies test (immunobead).
S4011	In vitro fertilization; including but not limited to identification and incubation of mature oocytes, fertilization with sperm, incubation of embryo(s), and subsequent visualization for determination of development.
S4015	Complete in vitro fertilization cycle, NOS case rate.
S4016	Frozen in vitro fertilization cycle, case rate.
S4017	Incomplete cycle, treatment canceled prior to stimulation, case rate.
S4018	Frozen embryo transfer procedure canceled before transfer, case rate.
S4020	In vitro fertilization procedure cancelled before aspiration, case rate.
S4021	In vitro fertilization procedure cancelled after aspiration, case rate.
S4022	Assisted oocyte fertilization, case rate.

1–10 of 21

1/3

ICD-10 Codes (informational)ICD-10

N46.01 - N46.9	Male infertility.
N97.0 - N97.9	Female infertility.

Assisted oocyte fertilization count

CPT codes89280 = Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes

CPT codes89281 = Assisted oocyte fertilization, microtechnique; greater than 10 oocytes

ThresholdBilling distinguishes procedures by oocyte count: <=10 versus >10 (use 89280 for <=10 and 89281 for >10)

Provider Responsibilities, Prior Authorization, and Billing

Prior Authorization

Verify member benefits and medical necessity before ordering services

When verifying benefits, confirm the member's specific plan provides coverage for the requested infertility or fertility preservation service and that the service meets JHHP medical necessity criteria. Use the member's SPD, applicable regulatory guidance (e.g., COMAR, TRICARE, Medicare LCD/NCD), and plan documents to determine benefit applicability and any prior authorization requirements.

Confirm member-specific coverage via the plan SPD or regulatory guidance listed for the member's line of business.
Ensure the service meets JHHP medical necessity criteria (JHHP infertility definition and sequence requirements) before authorization or scheduling.

Prior Authorization

Preauthorization required for all inpatient admissions and benefit determinations

Obtain preauthorization for all inpatient admissions; benefit coverage determinations (including whether a service is covered) must be made according to the member's specific benefit plan document and applicable laws/regulatory guidance.

Background and Epidemiology

Johns Hopkins Health Plans defines infertility as failure to achieve conception after specified durations of unprotected heterosexual intercourse or when there are qualifying diagnoses. The timing criteria are 12 months of unprotected intercourse for women younger than 35 years and 6 months for women aged 35 years or older, or the presence of medical conditions known to cause infertility (for example, Stage III/IV endometriosis, oligomenorrhea/amenorrhea, tubal blockage/removal, abnormal male factors), recurrent pregnancy loss, or infertility related to covered gender‑affirming treatment. The policy covers diagnostic evaluation and treatment to correct identified causes and, where benefits exist, assisted reproductive technologies and fertility preservation services according to the detailed medical necessity criteria.

Key Definitions

Infertility (JHHP definition)

Definition (JHHP)Failure to achieve conception after 12 months of unprotected heterosexual intercourse or medically supervised donor insemination for women <35 years, or after 6 months for women ≥35 years; or presence of known medical diagnoses causing infertility (e.g., Stage III/IV endometriosis, oligomenorrhea/amenorrhea, tubal blockage/removal, abnormal male factors), recurrent pregnancy loss, or infertility related to covered gender-affirming treatment.

Evaluation timingInitiate evaluation at 12 months when female partner is under 35 years and at 6 months when female partner is 35 years or older (ASRM 2023).

Alternate qualifying criteriaKnown medical diagnoses causing infertility (surgically diagnosed Stage III/IV endometriosis, pelvic adhesions, tubal removal/blockage), recurrent pregnancy loss (>=2 losses), or infertility related to gender-affirming treatment.

Assisted Hatching

DefinitionAssisted Hatching: An ART procedure in which the zona pellucida of an embryo is thinned or perforated by chemical, mechanical, or laser methods (Zeigers-Hochschild, 2017).

Policy Summary

Payerjohns_hopkins_health_plans

PolicyInfertility Treatment and Fertility Preservation

Policy CodePolicy CMS23.07

Change TypeNo material change

Effective DateOct 1, 2025

Last ReviewOct 1, 2025

Next Review DateN/A

SourceLink

On This Page

All inpatient admissions require preauthorization per the policy coding disclaimer.

Refer to the member's benefit plan document and relevant regulatory guidance (e.g., Medicare, COMAR, TRICARE) for coverage determination.

Prior Authorization

Confirm plan-specific handling of case-rate (S-code) services

Verify whether the member's plan treats listed HCPCS S-codes as case-rate (bundled) services and whether plan-specific prior authorization or verification is required for those case-rate codes.

Case-rate S-codes listed include S4011–S4042 and others describing bundled IVF cycles, frozen cycles, donor services, sperm procurement, and storage.
Confirm plan-specific rules for billing and prior authorization of case-rate services before submission.

Prior Authorization

No explicit universal prior authorization list in this excerpt — verify per plan

The policy excerpt does not list explicit universal prior authorization requirements or identify a defined set of CPT/HCPCS codes that always require prior authorization; use the member's plan documents to determine any specific prior authorization rules.

No explicit one-size-fits-all prior authorization mandate for specific outpatient codes is stated in the excerpt.
Always check the member's SPD or applicable regulatory guidance for plan‑level prior authorization rules.

Note

Sequence treatments logically (consider IUI before IVF; FET before a new fresh IVF)

Follow a logical, cost‑effective sequence of diagnostics and treatments—for example, consider attempting IUI prior to IVF when feasible and consider frozen embryo transfer prior to initiating a new fresh IVF cycle.

Sequence diagnostic and treatment services per JHHP guidance (IUI before IVF when feasible).
Facilities performing ART must conform to ASRM standards.

Note

No provider action specified

No content available in the source to populate this callout.

Note

No provider action specified

No content available in the source to populate this callout.

Step Therapy

No step therapy requirements stated; follow cited clinical guidelines

There are no step therapy requirements stated in this excerpt. Multiple professional society guidelines and references are cited to support clinical decisions; use these sources to guide appropriate sequencing and clinical management when documenting necessity.

No mandated step therapy is specified in the policy excerpt.
Referenced guidelines include ASRM, AUA, ESHRE, ASCO, NCCN, and UpToDate among others.

Documentation Required

Document JHHP infertility criteria and prior diagnostics/treatments

Document evidence that the member meets the JHHP definition of infertility (duration criteria or qualifying diagnoses) and record the logical trial of indicated diagnostics and treatments (for example, attempted IUI prior to IVF when feasible) to support medical necessity.

Record duration of unprotected heterosexual intercourse or qualifying medical diagnoses per JHHP definition (12 months if <35 years; 6 months if ≥35 years).
Document prior diagnostic evaluations and treatments and rationale for proceeding to ART or fertility preservation.

Documentation Required

Maintain documentation for potential monitoring and medical review audits

Adherence to this policy may be monitored through post-payment data analysis and/or medical review audits; maintain complete supporting documentation for services billed under this policy.

Keep records of clinical indications, prior treatments, and benefit verification to respond to potential audits.
Claims and clinical documentation may be subject to post-payment review.

Billing Rule

Include exact CPT/HCPCS codes and supporting documentation on claims

When submitting claims, include the exact CPT and HCPCS codes listed in the policy for the service provided and attach supporting clinical documentation for services such as cryopreservation, storage, and assisted fertilization.

Example CPT/HCPCS referenced: 89250–89281, 89300–89356, 89398, G0027, S3655, and S4011–S4042 series (HCPCS S-codes).
HCPCS codes are listed for informational purposes; verify coverage and payment with the member's plan.

Note

Reference professional society guidelines (ASRM, AUA, ESHRE, ASCO, NCCN, UpToDate, etc.)

The policy cites multiple professional society and evidence sources (ASRM, AUA, ESHRE, ASCO, NCCN, UpToDate, CDC, WHO, and others) that should be referenced for clinical decision-making and documentation; the excerpt does not mandate a specific required checklist tied to these references.

Use ASRM and AUA standards when performing ART and documenting patient care.
Clinical evidence and guideline references are provided to support policy decisions.

Denial Risk

Risk of denial for experimental or investigational infertility services

Services listed as experimental or investigational in the policy (for example, cryopreservation/freezing/thawing/storage of immature oocytes or testicular tissue; reimplantation of cryopreserved testicular tissue; leukocyte immunization; uterine transplantation; specified sperm function tests; uterine receptivity testing) are considered not covered and may be denied.

Examples of potentially denied investigational services: cryopreservation of immature oocytes or testicular tissue; reimplantation of cryopreserved testicular tissue; leukocyte immunization; uterine and endometrial receptivity testing; listed specialized sperm function assays.
Any service determined to be investigational or experimental per the policy is not medically necessary and may be denied.

Prior Authorization

Obtain preauthorization for inpatient admissions to avoid denial

All inpatient admissions require preauthorization; failing to obtain required preauthorization may lead to denial or lack of payment for inpatient services.

Obtain preauthorization prior to admission for inpatient procedures related to infertility or fertility preservation.
Verify inpatient authorization requirements with the member's plan document.

Billing Rule

Align billing method (case-rate S-codes vs CPT) with plan definitions to avoid payment issues

Ensure that billing aligns with how the plan recognizes services—some IVF and related reproductive services may be billed as case-rate HCPCS S-codes (e.g., S4015–S4042) or as individual procedure CPT codes; billing must match the service definition and case-rate designation to avoid payment issues.

Confirm whether the plan requires case-rate billing (S4011–S4042) or separate CPT billing for the services provided.
Mismatch between billed codes and plan-designated case-rate definitions can result in payment problems.

Denial Risk

No explicit denial triggers listed in excerpt — but denials may result from lack of coverage, investigational services, or missing authorization/documentation

No explicit denial triggers are identified in this document excerpt; however, denials may occur if services are not covered by the member's plan, are investigational per the policy list, lack required preauthorization for inpatient admissions, or are unsupported by clinical documentation of medical necessity.

Policy excerpt states no explicit denial triggers but lists investigational services that may be denied.
Verify coverage, obtain required authorizations, and document medical necessity to reduce denial risk.

PurposePerformed to assist embryo implantation by altering the zona pellucida integrity.

MethodsCan be done by chemical, mechanical, or laser techniques as described in policy glossary.

Assistive Reproductive Technologies (ART)

DefinitionAssistive Reproductive Technologies (ART): Treatments that include handling of eggs and sperm and/or embryos (e.g., IVF, GIFT, PROST, TET, ZIFT); generally involve surgically removing eggs, combining with sperm in the lab, and returning embryos to a woman's body or donating them.

ScopeDoes not include procedures where only sperm are handled (e.g., IUI) or medication-only ovarian stimulation without egg retrieval.

ExamplesIn vitro fertilization (IVF) and related laboratory procedures such as embryo culture and transfer (see CPT codes 89250–89272, 58970).

Attempt

DefinitionAttempt: Any implantation of an embryo into the uterus; each attempt is called a cycle.

Clarification'Attempt' refers to the implantation/event, not stimulation or oocyte retrieval alone.

SynonymEach 'attempt' = an ART cycle involving embryo transfer (fresh or frozen).

Cryopreservation

DefinitionCryopreservation: The process of slow freezing or vitrification to preserve biological material (gametes, zygotes, embryos) at extremely low temperatures.

Covered processesIncludes cryopreservation, thawing, and storage of embryos, sperm, oocytes, and reproductive tissue (see CPT 89258–89259; 89335–89337; 89342–89346).

DocumentationClaims should include the exact CPT/HCPCS codes for cryopreservation, thawing, and storage as listed in policy coding sections.

In Vitro Maturation (IVM)

DefinitionIn Vitro Maturation (IVM): Maturation culture of immature oocytes after recovery from follicles that may or may not have been exposed to exogenous FSH but were not exposed to exogenous LH or hCG prior to retrieval to induce meiotic resumption.

ContextTerm referenced per ASRM (2013) in policy glossary; IVM is listed among procedures evaluated in policy.

Policy stanceIVM is listed in the policy's investigational/not-covered items (see investigational services sections).

Premature Ovarian Insufficiency (POI)

DefinitionPremature Ovarian Insufficiency (POI): A condition characterized by hypergonadotropic hypogonadism in women younger than age 40 years; includes premature menopause.

SynonymsAlso known as primary ovarian insufficiency or premature ovarian failure.

Clinical relevanceListed as a defined term in policy glossary and may qualify as a diagnosis contributing to infertility evaluation/treatment.

Infertility

DefinitionInfertility: The inability to achieve a successful pregnancy based on medical, sexual, reproductive history, age, physical findings, diagnostic testing, or combination thereof; may require medical intervention including donor gametes or embryos.

Evaluation timingInitiate evaluation at 12 months for women <35 years and at 6 months for women ≥35 years when regular unprotected intercourse and no known etiology exist.

IncludesRecurrent pregnancy loss and other medical diagnoses causing infertility; referenced in JHHP general criteria for coverage.

In vitro fertilization (IVF) / Assisted reproductive services

Covered proceduresIn vitro fertilization (IVF) and assisted reproductive services including oocyte retrieval (58970), embryo culture and transfer (89250, 89272, 89274 series, 58974), assisted fertilization techniques (89280, 89281), and associated laboratory processes and storage (89258–89259; 89342–89346).

ScopeCovers both fresh IVF cycles and frozen embryo transfers when benefits apply; includes associated lab procedures and cryopreservation services listed in coding section.

Billing noteProviders must submit exact CPT/HCPCS codes as listed; some services may be billed as case-rate HCPCS S-codes (S4011–S4042).

Case-rate HCPCS S-codes

DefinitionCase-rate HCPCS S-codes: Codes that describe bundled or case-rate payments for complete IVF cycles, frozen cycles, cancelled cycles, donor services, sperm procurement and cryopreservation, and other bundled reproductive services (S4011–S4042).

ExamplesIncludes S4015 (complete IVF cycle, NOS case rate), S4016 (frozen IVF cycle, case rate), S4027 (storage of previously frozen embryos), S4035 (stimulated IUI, case rate), S4040 (monitoring and storage of cryopreserved embryos, per 30 days).

Billing cautionHCPCS S-codes are informational; verify plan-specific prior authorization and case-rate reporting to avoid payment issues.

Assisted Reproductive Technology (ART)

Term referenceAssisted Reproductive Technology (ART): Term referenced via CDC and policy resources; specific CDC definition text is cited in references but not reproduced in this excerpt.

Policy notePolicy refers to ART per standard public health definitions and external CDC guidance; consult referenced sources for expanded CDC wording.

Cross-referenceSee Definitions and coding sections for list of ART procedures and associated CPT codes included under covered services when benefits apply.

Standards of Care for transgender and gender diverse people

ReferenceStandards of Care for transgender and gender diverse people are acknowledged via WPATH (World Professional Association for Transgender Health) reference; specific definition content is not provided in this excerpt.

Policy usagePolicy includes infertility related to covered gender-affirming treatment as a qualifying criterion where benefits apply.

SourceWPATH Standards of Care (8th Version) cited in references (WPATH, 2022).