Questions to ask your insurance (with exact CPT codes)
A scripted call sheet so you get real answers the first time.
The call sheet
Have your insurance card, member ID, and prescription benefits info in front of you. Ask the rep for their name and a reference number for the call. Take notes verbatim. Always end with: 'Can I get this in writing?'
Diagnostic coverage questions
1. Are diagnostic tests for infertility covered under my plan? Specifically CPT 58340 (HSG), 89320 (semen analysis), 80426 (FSH), 83520 (AMH)?
2. Do I need a referral from my OB/GYN to see a reproductive endocrinologist?
3. Is there a separate deductible for fertility services?
Treatment coverage questions
1. Does my plan cover IUI (CPT 58322) and the associated monitoring (76830, 76857)?
2. Does my plan cover IVF (CPT 58970, 58974, 58976, 89250, 89272, 89342)?
3. Is ICSI (CPT 89280) covered? PGT-A (CPT 89290–89291)?
4. Are there cycle limits or a lifetime dollar maximum?
5. What is the precise definition of 'infertility' in my plan?
Pharmacy questions
1. Are injectable fertility medications (Gonal-F, Follistim, Menopur, Cetrotide) covered under medical or pharmacy benefits?
2. Which specialty pharmacy do I have to use?
3. Is there prior authorization?
4. What is the copay or coinsurance per cycle?
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Cited figures (cycle counts, dollar ranges, mandate lists) reflect publicly available data as of early 2026. Always confirm specific numbers against the linked sources before relying on them — pricing, protocols, and laws change.
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