CPT 89337 is referenced in 4 tracked payer policy changes from Sentara Health Plans, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 89337 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
The assisted reproductive technologies policy (4.01.05) has a current effective date of April 15, 2026, following the 12/18/25 annual update that added a diagnosis of infertility as criteria for IVF, added a guideline that preimplantation genetic testing is not an indication for IVF, and added a guideline for fertility preservation. Under the policy, IVF is medically appropriate when a diagnosis of infertility has been made and a successful pregnancy has not been achieved after six to 12 cycles of assisted insemination for individuals younger than 35, or after three to six cycles for individuals 35 or older, and other reasonable, less expensive infertility treatments have not resulted in a successful pregnancy. ART are not medically necessary for members who have undergone permanent birth control procedures, and IVF cycles initiated for the sole purpose of embryo banking are considered not medically necessary.
Blue Cross NC updated 40+ commercial medical policies on April 15, 2026, with most changes being administrative updates to descriptions, references, and guidelines. Key billing changes include removal of numerous fertility treatment codes from coverage and addition of specific billing guidance for sleep apnea devices using code E0486.
Healthfirst covers infertility and fertility preservation services based on the member's benefit plan, and coverage differs by line of business. Essential Plan and Qualified Health Plan members receive basic infertility treatment, including prescription drugs, and Medicaid Managed Care and HARP infertility benefits are limited to three treatment cycles per lifetime. Excluded services include in vitro fertilization, gamete and zygote intrafallopian transfer, donor ova and sperm costs, embryo cryopreservation, reversal of tubal ligation or vasectomy, and surrogacy costs.
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