Infertility

Coverage for infertility diagnosis and treatment is provided only when a member’s specific benefit plan includes infertility services and generally covers basic diagnostic evaluations and medically necessary serum hormone and lab testing as listed (e.g., AMH, FSH/LH, prolactin, TSH, infection screening, karyotype for recurrent loss). Exclusions/requirements: many plans exclude prior sterilization, hysterectomy, natural menopause, and some egg‑use cases (ovarian reserve rules: women <40 generally need day‑3 FSH <19 mIU/mL [most recent]; women ≥40 need unmedicated day‑3 FSH <19 mIU/mL in prior tests), services are not covered after a fetal heartbeat is detected, and precertification is required for specified infertility drugs.

"N98."

Sign up to see full coverage criteria, indications, and limitations.