Does 55870 require prior authorization?

No, 55870 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 55870?

Medicare facility rate: $127.59. Non-facility rate: $185.37. Work RVU: 2.52.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

2.52

Facility

$127.59

Non-Facility

$185.37

Cross-reference: criteria related to cryopreservation are addressed in CP.MP.55 Assisted Reproductive Technologies (see that policy for cryopreservation requirements).
For individuals with a female reproductive system aged ≥40 requesting retrieval of their own oocytes, documentation that the treating provider has evaluated: age, infertility risk factors, and a measure of ovarian reserve, and that the provider considers use of the member's own oocytes a viable strategy for attempting future conception.
Documentation that the planned treatment causing risk to fertility is medically necessary.
Clinical documentation supporting the diagnosis and planned gonadotoxic or fertility-threatening therapy (as referenced by policy sections I and III stating the treatment causing risk must be medically necessary).

Patients undergoing bilateral oophorectomy with risk of loss of fertility.
Patients receiving gonadotoxic therapy (e.g., alkylating agents) with risk of infertility.
Patients receiving cytotoxic chemotherapy that may impair future fertility.
Patients receiving radiation therapy with potential gonadal exposure risking fertility loss.
Patients with other iatrogenic causes that may transiently or permanently affect fertility.
Ovarian stimulation and retrieval of oocytes for adults and adolescents with a female reproductive system prior to commencing medically necessary treatment likely to cause infertility (excluding voluntary sterilization).

AMBETTER-CP.MP.130 — Fertility Preservation

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