AI-Powered Fertility & IVF Billing Services

Q: What CPT codes cover IVF billing?

CPT 58970-58976 cover ART cycle procedures such as oocyte retrieval and embryo transfer, while CPT 89250-89280 cover embryology lab services including ICSI and assisted hatching. Each carries its own global-period and bundling rules.

Q: How do you bill fertility benefit managers like Progyny or Maven?

Fertility benefit managers each have distinct prior authorization workflows, coverage caps, and claim-submission portals separate from standard commercial insurance billing. We track authorization and coverage limits per benefit manager, per patient.

Q: Are genetic testing services billed separately in IVF cycles?

Yes. PGT and other genetic testing services are frequently separately billable outside the ART global period, and missing this distinction is a common source of underbilling.

Q: Do state fertility mandates affect billing?

Yes. States including New York and Massachusetts have fertility coverage mandates that affect what must be covered and how claims should be coded, and these rules are applied per plan.

THE PROBLEM

Fertility billing has its own rulebook. Most billers don't read it.

✕ART cycle codes (58970-58976) and lab codes (89250-89280) billed incorrectly against global period rules

✕Fertility benefit managers — Progyny, Maven, WINFertility — each run separate prior auth and claims workflows

✕Separately billable genetic testing (PGT) missed inside the global period, leaving revenue on the table

✕State fertility mandates (NY, MA, and others) change what's billable and how, per plan

Sterling bills fertility like fertility, not generic OB-GYN.

Our AI is tuned to ART's specific coding structure, not a general reproductive-health filter.

✓ ART cycle and embryology lab codes validated against global period rules before submission

✓ Benefit manager authorization and coverage caps tracked per patient, per cycle

✓ Separately billable genetic testing and lab services flagged so they aren't bundled away

✓ State mandate rules applied automatically based on patient plan and location

WHERE THE MONEY LEAKS

The codes and rules that decide reimbursement.

🧪

ART Cycle Billing

CPT 58970-58976 for oocyte retrieval, embryo transfer, and related ART procedures.

CPT 58970-58976

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Embryology Lab Codes

CPT 89250-89280 for ICSI, assisted hatching, and lab services — often separately billable.

CPT 89250-89280

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Benefit Manager Billing

Progyny, Maven, and WINFertility each carry distinct authorization and claim workflows.

prior auth

⚖️

State Mandate Rules

NY, MA, and other state fertility coverage mandates applied per plan.

compliance

HOW WE WORK YOUR CLAIMS

Built around the cycle, not a generic visit.

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Verify

Benefit manager authorization and coverage limits confirmed before the cycle starts.

🔍

Scrub

ART and lab codes validated against global period and bundling rules.

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Track Mandate

State mandate and benefit manager rules applied per patient plan.

💰

Collect

Clean claims submit same-day; separately billable services aren't left uncaptured.

FAQ

What fertility clinics ask first.

What CPT codes cover IVF billing?

CPT 58970-58976 cover ART cycle procedures, while CPT 89250-89280 cover embryology lab services including ICSI. Each has its own global-period and bundling rules.

How do you bill fertility benefit managers like Progyny or Maven?

Each benefit manager has distinct prior authorization workflows and coverage caps, tracked per patient.

Are genetic testing services billed separately in IVF cycles?

Yes — PGT and related testing are frequently separately billable outside the ART global period.

Do state fertility mandates affect billing?

Yes. States including New York and Massachusetts have mandates that affect coverage and coding, applied per plan.

What EHR systems do you work with for fertility clinics?

We work inside the EHR and practice management system your clinic already uses.

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