Prior Auth Required

58976 - • Gamete intrafallopian transfer (GIFT) and follicle aspiration ( , )

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / Service• Gamete intrafallopian transfer (GIFT) and follicle aspiration ( , )
Procedure / Service Description

as any drugs associated with these services) are excluded from coverage. This list is not - considered to be all-inclusive. • In vitro fertilization beyond initial three cycles. • Gamete intrafallopian transfer (GIFT) and follicle aspiration (58976, S4013). • Sperm injection and assisted rupture (FASIAR). • Tubal embryo transfer (TET).

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.