Z31.84 — Encounter for fertility preservation procedure
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Benefit coverage is determined by the member specific benefit plan document and applicable laws; medical records documentation may be required to assess whether the member meets the clinical criteria for coverage (refer to the protocol titled 'Medical Records Documentation Used for Reviews').
- For medical necessity reviews, refer to the Clinical Guideline titled 'Fertility Solutions Medical Necessity Clinical Guideline: Infertility.'
- For fertility preservation for iatrogenic infertility claims, the claim must be submitted with diagnosis code Z31.84 for the fertility preservation benefit to apply.
- Documentation to establish Infertility per the policy definition (examples include: detailed reproductive and sexual history, documentation of inability to achieve pregnancy per the policy definition such as failure to conceive after appropriate duration of unprotected intercourse or other clinical evidence of infertility).
Key Coverage Criteria
- Antisperm antibodies testing
- Antral follicle count
- Cryopreservation of sperm, semen, or embryos for individuals who are undergoing treatment with assisted reproductive technologies or are planning to undergo therapies that threaten their reproductive health (e.g., cancer chemotherapy)
- Cryopreservation of surgically derived sperm
- Cryopreservation of mature oocytes (eggs) for women who are undergoing treatment with assisted reproductive technologies or are planning to undergo therapies that threaten their reproductive health (e.g., cancer chemotherapy)
- Cryopreservation of supernumerary embryos or in the setting where the intent is to freeze all embryos for the purpose of an elective single embryo transfer
1 Active Policy
UHC-POL-infertility-diagnosis-treatment — Infertility Diagnosis, Treatment, and Fertility Preservation
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