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Infertility Services – Commercial Coverage Determination ...

Infertility Services Page 1 of 5 UnitedHealthcare Commercial Coverage Determination Guideline Effective 01/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services , Inc. UnitedHealthcare Commercial Cover a ge Deter mina tion Guideline Infertility Services Guideline Number: Effective Date: January 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 3 Definitions .. 4 References .. 4 Guideline History/Revision Information .. 5 Instructions for Use .. 5 Coverage Rationale Indications for Coverage Check the member specific benefit plan document for inclusion or exclusion. Some states mandate benefit Coverage for Infertility Services .

Coverage Rationale . Indications for Coverage Check the member specific benefit plan document for inclusion or exclusion. Some states mandate benefit coverage for Infertility services. Refer to state mandates. Services for the treatment of Infertility when provided by or under the care or supervision of a Physician are limited to the

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