Physicians hope a coding change for cryopreservation will drive more insurers to cover the procedure.
Starting in 2015, cryopreservation of mature oocytes can be reported using a Category I CPT code, rather than a Category III code, which is associated with experimental procedures.
The shift will hopefully lead to the procedure becoming more accessible to patients by influencing insurers to pay for the treatment, said Dr. George Hill , a Nashville reproductive endocrinologist and former chair of the American Society of Reproductive Medicine’s (ASRM) coding committee.
The new CPT code is 89337 for cryopreservation of mature oocytes. It was previously reported with code 0059T, which has been deleted. Details about the coding change were announced by ASRM in late January.
“This is a real advantage to physicians that this has been recognized as a mainstream procedure,” said Dr. Hill, who is ASRM’s current treasurer. “When you’ve got a Category I code, it takes away a little of the stigma of being experimental.”
The American College of Obstetricians and Gynecologists (ACOG) said in a January 2014 opinion that cryopreservation of oocytes should no longer be considered experimental for women facing infertility as a result of chemotherapy or other gonadotoxic therapies.
The ACOG guidelines endorsed a joint 2013 document from ASRM and the Society for Assisted Reproductive Technology that also advocated removing the experimental label. The decisions were fueled by improvements in mature oocyte cryopreservation and the increasing survival rates of cryopreserved mature egg cells, according to the opinions, but both policy statements stopped short of recommending oocyte crypreservation solely for delaying childbearing in healthy women.
The popularity of cryopreservation has exploded in recent years, with more women seeking the service for various reasons, said Dr. Mitchell Rosen, director of the University of California, San Francisco’s fertility preservation center , which specializes in helping cancer patients preserve their fertility prior to treatment.
“It is now almost common practice to see patients coming in electively wanting to freeze their eggs,” he said in an interview. “More and more women are delaying child bearing. They want to have opportunities to expand their reproductive potential so they’re not forced into situations or possibly not able to have children in the future.”
Despite the demand and removal of the experimental designation, however, Dr. Rosen has not seen more insurance companies opt to cover the procedure. Only 15 states mandate benefit coverage for certain infertility services, including cryopreservation, but the laws vary widely. Most states require coverage only after a patient has been diagnosed as infertile.
“For patients who are undergoing medical treatment that would render significant reproductive impairment, that doesn’t matter to insurance companies,” Dr. Rosen said. “This is [considered] a completely elective procedure.”
Dr. Hill said he is optimistic that the coding change could move more insurers to cover cryopreservation, especially in states that already mandate in-vitro fertilization coverage. “If more insurers companies cover the procedure, certainly, it’s going to help patients access the treatment,” he said.
Dr. Rosen is not certain if the coding difference will change how frequently the procedure is covered, but he strongly supports coverage for cryopreservation in cases in which women are likely to have significant reproductive impairment because of medical treatment.
“If it’s one step in the right direction of it ultimately being covered, then that’s great,” he said. “But I don’t know if changing the CPT code is going to make a difference.”
Meanwhile, the cryopreservation of immature oocytes remains experimental because there is insufficient clinical data to support its use in many clinical applications, according to ASRM. A new Category III CPT code (0357T) has been introduced for reporting cryopreservation of immature oocytes.
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