[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-403419-105":59,"doc-detail-403419-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","infertility-services-commercial-medical-policy","Infertility Services - Commercial - Medical Policy","","Infertility Services—Commercial provides EmblemHealth’s medical guideline framework for determining whether infertility-related services or supplies are medically necessary and eligible for prior authorization. It outlines how clinical criteria are developed from peer-reviewed literature, evidence-based guidelines, regulatory status, and expert clinical practice, while noting that benefit coverage is defined by each program and governed by the member’s benefits plan if there is a discrepancy. The document also includes definitions and covered services such as evaluation, laboratory testing, ovulatory function assessment, semen analysis, and infertility treatment approaches including IUI and IVF cycles.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/infertility-services-commercial-medical-policy/403419/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/infertility-services-commercial-medical-policy/403419.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-27",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How does EmblemHealth decide if an infertility service is medically necessary?","Question",{"text":113,"@type":114},"The guideline explains that clinical review criteria reflect how EmblemHealth determines medical necessity using currently available clinical information, including peer-reviewed studies, evidence-based guidelines, regulatory status, and professional organizations’ positions.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What is the definition of infertility used in this policy?",{"text":118,"@type":114},"Infertility is defined by failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after 6 months for females age 35 or older, with earlier evaluation potentially warranted based on medical history or physical findings.",{"name":120,"@type":111,"acceptedAnswer":121},"Which infertility treatments fall under covered services such as IUI and IVF?",{"text":122,"@type":114},"Covered services include fertility treatments and related evaluations, including intrauterine insemination (IUI) and in vitro fertilization (IVF). The policy also describes treatment cycles for fresh embryo transfer and frozen embryo transfer using appropriate medication-based preparation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},403419,1791116864,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Infertility Services—Commercial  \nLast Review Date: June 12, 2026  \nNumber: MG. MM. ME.53kv2  \nMedical Guideline Disclaimer  \nProperty of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the patient meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request for prior authorization. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors) . EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication. EmblemHealth Services Company LLC,(“EmblemHealth”) has adopted the herein policy in providing management, administrative and other services to EmblemHealth Plan, Inc., EmblemHealth Insurance Company, EmblemHealth Services Company, LLC and Health Insurance Plan of Greater New York (HIP) related to health benefit plans offered by these entities. All of the aforementioned entities are affiliated companies under common control of EmblemHealth Inc.  \nRelated Medical Guidelines  \nRecurrent Pregnancy Loss  \nDefinitions  \n\n| Infertility | “Infertility” is a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after twelve (12) months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six (6) months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female thirty-five (35) years of age or older. Earlier evaluation and treatment may be warranted based on a member’s medical history or physical findings (See also NYS Mandate Section) |\n| --- | --- |\n| Iatrogenic infertility | An impairment of fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes.\u003Cbr>Note: EmblemHealth covers standard fertility preservation services when a medical treatment will directly or indirectly lead to iatrogenic infertility. Standard fertility preservation services include the collecting, preserving, and storing of ova and sperm. |\n| Male infertility | Mild Male Factor: Abnormalities in the semen analysis where the sperm concentration is 10- 15 million/mL, motility is 30–40%, and normal morphology at 2-3%\u003Cbr>Moderate Male Factor: Abnormalities in the semen analysis where the sperm concentration is 5–10 million/mL and motility is 25–30%, and normal morphology at 2-3%\u003Cbr>Severe Male Factor: Abnormalities in the semen analysis where the sperm concentration is less than 5 mill","cbCait1TqmiY80WX","https://ap.wps.com/l/cbCait1TqmiY80WX","pdf",383458,18,"English","# Definitions\n## Infertility\n## Iatrogenic infertility\n## Male infertility\n## IUI\n## IVF\n## Cycle\n# Covered Services\n## Basic infertility services\n## Comprehensive infertility services\n## Advanced infertility services","[{\"question\":\"How does EmblemHealth decide if an infertility service is medically necessary?\",\"answer\":\"The guideline explains that clinical review criteria reflect how EmblemHealth determines medical necessity using currently available clinical information, including peer-reviewed studies, evidence-based guidelines, regulatory status, and professional organizations’ positions.\"},{\"question\":\"What is the definition of infertility used in this policy?\",\"answer\":\"Infertility is defined by failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after 6 months for females age 35 or older, with earlier evaluation potentially warranted based on medical history or physical findings.\"},{\"question\":\"Which infertility treatments fall under covered services such as IUI and IVF?\",\"answer\":\"Covered services include fertility treatments and related evaluations, including intrauterine insemination (IUI) and in vitro fertilization (IVF). The policy also describes treatment cycles for fresh embryo transfer and frozen embryo transfer using appropriate medication-based preparation.\"}]","Infertility Services - Commercial - Medical Policy | PDF",1790540327,45]