Z31.41 — Encounter for fertility testing
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation of age and sexual activity status (e.g., sexually active women aged 24 years and younger) to support coverage for routine screening.
- Documentation of risk factors for women aged 25 years and older (e.g., prior C. trachomatis or other STDs, new or multiple sexual partners, inconsistent or incorrect condom use) to support screening coverage.
- Documentation of indication prior to uterine instrumentation for assessment and treatment of infertility (screening prior to uterine instrumentation).
- Clinical documentation of signs or symptoms of C. trachomatis infection to support diagnostic testing (history and physical, symptom description, clinician assessment).
Key Coverage Criteria
- Chlamydia screening is recommended for the following groups: Women 25 years and older with any of the following risk factors for C. trachomatis infection: Having had C. trachomatis or other sexually transmitted diseases in the past;
- Chlamydia screening is recommended for the following groups: Women 25 years and older with any of the following risk factors for C. trachomatis infection: New or multiple sexual partners;
- Chlamydia trachomatis (C. trachomatis) screening a medically necessary preventive service according to the recommendations of the National Institute for Health and Clinical Excellence, United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC).
- Chlamydia screening is recommended for the following groups: All pregnant women in the first trimester;
- Chlamydia screening is recommended for the following groups: All sexually active women aged 24 years and younger;
- ICD-10 codes covered if selection criteria are met: Z72.51 - Z72.53 (High-risk sexual behavior)
3 Active Policies
HUMANA-ABORTION-HYSTERECTOMY-AND-STERILIZATION-LA-MEDICAID — Abortion, Hysterectomy and Sterilization - MEDICAID - LOUISIANA
AETNA-CPB-0327 — Infertility
AETNA-CPB-0433 — Chlamydia Trachomatis - Screening and Diagnosis
Related Codes
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