Egg Freezing (Oocyte Cryopreservation) - Medical Necessity Criteria
Criteria for documenting medical necessity of egg freezing (oocyte cryopreservation).
Contents:
- Does insurance cover egg freezing?
- Medical necessity criteria for oocyte cryopreservation (egg freezing)
- Frequently Asked Questions
- Documentation to Submit
- Health plan criteria for egg freezing / oocyte cryopreservation and other references
Does insurance cover egg freezing?
Health insurance companies may cover egg freezing — if covered and not specifically excluded in the benefit plan contract — for women who are about to start medically necessary treatment procedures that are likely to cause infertility. Check the terms and conditions in the benefit plan contract as well as the medical necessity criteria used by the health insurance company.
The medical term for egg freezing is oocyte cryopreservation. Note that:
- Health plans often have different policies for mature oocytes and immature oocytes.
- “Gamete cryopreservation” is a general term for both egg freezing and sperm freezing.
- Oocyte cryopreservation (egg freezing) is different from embryo cryopreservation; in the latter, the eggs have already been fertilized.
Medical necessity criteria for oocyte cryopreservation (egg freezing)
Cryopreservation of mature oocytes may be considered medically necessary for women and adolescent girls prior to commencing treatment that is likely to cause infertility (excluding voluntary sterilization). Such treatments that may result in iatrogenic infertility include, but are not necessarily limited to:
- chemotherapy
- pelvic radiotherapy
- other gonadotoxic therapies
- ovary removal for treatment of disease
- prophylactic oophorectomy due to certain genetic conditions, such as BRCA mutations
A few health plans may also cover mature oocyte cryopreservation in the context of anticipated infertility as a result of medically necessary gender confirming treatment.
Finally, some health plans may also consider oocyte or embryo cryopreservation medically necessary when it is being done in association with ongoing infertility care — that is, when infertility treatment is done within 90 days of the cryopreservation.
Limitations/exclusions:
- Many health plans do NOT consider oocyte cryopreservation medically necessary when the procedure is performed to:
- provide donor oocytes; or
- conserve future childbearing potential due to reproductive aging.
- If cryopreservation is done in association with ongoing infertility care, the following may NOT be covered:
- Long-term (greater than 90 days) oocyte or embryo storage, unless the couple is actively receiving infertility treatment
- Cryopreservation beyond 90 days after the last cycle of infertility treatment ends, or if a pregnancy occurs
- The following procedures are generally considered experimental, investigational, and/or unproven:
- Cryopreservation of immature oocytes
- Routine use of oocyte/gamete cryopreservation in lieu of embryo cryopreservation
- Oocyte/gamete cryopreservation to circumvent reproductive aging in healthy persons
- Laser-assisted necrotic blastomere removal from cryopreserved embryos
- Cryopreservation, storage, thawing, and re-transplantation of ovarian reproductive tissue
Reminder: Cryopreservation of reproductive tissue, including sperm and oocytes, may not be covered under standard medical benefits or under infertility benefits. Always check the relevant terms and conditions of the patient’s benefit plan. Cryopreservation services may also be governed by state mandates.
Frequently Asked Questions
What is the age limit for egg freezing?
Some health insurance companies do specify an age limit for medically necessary egg freezing. An example is the health plan that states that cryopreservation of mature oocytes is considered medically necessary “for women under the age of 42 who are undergoing treatment with assisted reproductive technologies or are planning to undergo therapies that threaten their reproductive health, such as cancer chemotherapy.”
Does insurance cover egg freezing for cancer patients?
Generally, health insurance companies consider egg freezing medically necessary for women who are about to undergo treatments that are likely to cause infertility. These treatments include chemotherapy and radiation therapy for cancer. Some health plans also cover egg freezing for women who will undergo prophylactic oophorectomy due to BRCA mutations.
What companies cover egg freezing?
Health insurance companies that cover egg freezing when medically necessary include Aetna, Blue Cross / Blue Shield, and United Healthcare. However, coverage and medical necessity criteria vary among insurance companies — as well as between specific plans within the same insurance company — so make sure to check the terms and conditions in the benefit plan contract and the medical necessity criteria used by the company.
Does Aetna cover egg freezing?
Aetna may cover egg freezing — specifically, cryopreservation of mature oocytes — in women who are about to undergo treatments that are likely to cause infertility, such as chemotherapy, pelvic radiotherapy, and ovary removal. However, this is subject to the benefits and exclusions stated in the individual’s contract, so make sure to check their benefit plan descriptions.
Does Blue Cross / Blue Shield cover egg freezing?
Blue Cross and Blue Shield generally cover cryopreservation of mature oocytes in individuals post-puberty who are likely to become infertile as a result of chemotherapy or radiation therapy. Some Blue Cross / Blue Shield health plans cover egg freezing for other medically necessary indications. To determine coverage or non-coverage, make sure to check the patient’s contract benefits in effect at the time of service.
Does United Healthcare cover egg freezing?
Generally, United Healthcare may cover egg freezing for women under 42 years old who are undergoing assisted reproductive treatments or who will undergo procedures that are likely to cause infertility, such as chemotherapy. However, coverage for specific individuals is always subject to the terms and conditions of their benefit contract, as well as their fulfillment of the applicable medical necessity criteria.
Documentation to Submit
These are the things you can prepare documentation of in order to support your statement that egg freezing (oocyte cryopreservation) is medically necessary. Submit only those that apply.
Documentation of risk of iatrogenic sterilization:
Fertility-related documentation:
Health plan criteria for egg freezing / oocyte cryopreservation and other references
- Aetna Criteria for Infertility
- AllWays Health Partners Medical Policy on Assisted Reproductive Services/Infertility Services
- Anthem Blue Cross Criteria for Cryopreservation of Oocytes or Ovarian Tissue
- Blue Cross Blue Shield of North Carolina Criteria for Infertility Diagnosis and Treatment
- Blue Cross Blue Shield of North Dakota
- Blue Cross Blue Shield of Rhode Island Medical Coverage Policy on Infertility Services
- Blue Shield of California Medical Policy on Reproductive Techniques
- Cigna Criteria for Infertility Services
- EmblemHealth Medical Policy on Infertility Services
- Harvard Pilgrim Health Care Medical Policy on In Vitro Fertilization (IVF) and Other Fertility Services
- Health Net / Centene Corporation Criteria for Fertility Preservation
- Premera Blue Cross Benefit Coverage Guideline on Infertility and Assisted Reproduction Services
- Tufts Health Plan Medical Necessity Guidelines for Infertility Services (Massachusetts Products)
- UnitedHealthcare Commercial Medical Policy on Infertility Diagnosis and Treatment
- UnitedHealthCare Oxford Clinical Policy on Infertility Diagnosis and Treatment