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Assisted Reproductive Technologies – In Vitro Fertilization Medical Policy Update Effective April 14, 2022

Audience: OB/GYNs and Endocrinologists

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on our website for review and comment. Providers now have the capability of attaching supporting documentation related to their comments.

The following updated medical policy has been reviewed and was approved on December 16, 2021 by the Corporate Medical Policy Committee including practitioner representatives from all Health Plan regions. The policy is effective April 14, 2022 for all lines of business and applies to services of all practitioners and facilities.

4.01.05 – Assisted Reproductive Technologies – In Vitro Fertilization has been updated for clarity and to be consistent with The American Society for Reproductive Medicine, The American College of Obstetricians and Gynecologist recommendations, as well as New York State Insurance Law §4303 – Benefits related to the treatment of infertility.

Policy updates include:

  • Requirements for the number of assisted insemination attempts required prior to moving forward with in vitro fertilization (IVF)
  • Clarification regarding IVF cycles for the purposes of embryo banking and pre-implementation genetic testing
  • Clarification of cycle definitions 
  • Indications for counseling on lifestyle and behavioral modification 
  • Clinical contraindications to infertility treatment

The Description section of the medical policy provides information related to the Health Plan’s clarification of criteria based on New York state laws.

These services are subject to audit and policy updates at the Health Plan’s discretion. Access the individual policies.

If you have questions regarding this policy, please contact your Provider Relations representative.

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