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Billing MBS items for Assisted Reproductive Technology (ART) services
| MBS items | Brief description | Billing date | Item notes |
|---|---|---|---|
| 13200 | Initial cycle - superovulated treatment cycle proceeding to oocyte retrieval | First day of treatment cycle | Nil. |
| 13201 | Subsequent cycle - superovulated treatment cycle proceeding to oocyte retrieval | First day of treatment cycle | You must have previously billed an item 13200 or 13202 in the same calendar year. |
| 13202 | Superovulated treatment cycle - cancelled before oocyte retrieval | First day of treatment cycle | For an initial or subsequent cycle that is cancelled before oocyte retrieval. |
| 13203 | Ovulation monitoring services for artificial insemination | First day of treatment cycle | Nil. |
| 13207 | Embryo biopsy for Pre-implantation Genetic Testing (PGT) | Date service provided | The patient fulfils the criteria of item 73384. Payable per embryo produced in an ART treatment cycle. |
| 13209 | Planning and management for treatment by either ART or artificial insemination. | First day of treatment cycle | Bill with the same date of service as the appropriate global item - 13200, 13201, 13202, 13203 or 13218. |
| 13212 | Oocyte retrieval for ART purposes | Date service provided | Provide in conjunction with 1 of the following items: 13200 or 13201. |
| 13215 | Transfer of embryos, or both ova and sperm, to the uterus or fallopian tubes | Date service provided | Provide in conjunction with 1 of the following items: 13200, 13201 or 13218. |
| 13218 | Preparation of frozen or donated embryos, or donated oocytes, for transfer to the uterus or fallopian tubes | First day of treatment cycle | Do not provide in conjunction with items 13200, 13201, 13202, 13203 or 13212. |
| 13221 | Preparation of semen for artificial insemination | Date service provided | Do not provide for IVF purposes. Provide in conjunction with item 13203. |
| 13241 | Open surgical testicular sperm retrieval, unilateral, using operating microscope | Date service provided | Only performed as inpatient service. Not with item 13218 or 37604. |
| 13251 | Intracytoplasmic sperm injection for male factor infertility | Date service provided | Don’t provide with item 13203 or 13218 in the same treatment cycle. Items 37605 and 37606 cover sperm retrieval procedures for intracytoplasmic sperm injection. Items 13251, 37605 and 37606 don’t include services for artificial insemination. |
Billing for failed treatment cycle
| Treatment cycle fails | Cycle is | MBS item billing |
|---|---|---|
| After oocyte retrieval | Unsuccessful | 13200 - initial cycle or 13201 - subsequent cycle |
| Before oocyte retrieval | Incomplete | 13202 |
MBS items for billing donor and recipient services
You must bill services for donated ova against the donor and not the recipient. You can only perform ART services on a donor if you’ve identified a medically infertile recipient. This is because under Medicare a medically infertile recipient is a precondition for getting ART services. Medicare benefits can only apply if there’s a medical condition that requires treatment.
Donor services
Billing MBS items for patients donating their ova:
| MBS items | Item notes |
|---|---|
| 13200, 13201, 13202 | These items don’t include artificial insemination services. |
| 13209 | Nil. |
| 13212 | Nil. |
| 13221 | For the preparation of sperm for artificial insemination. Can be billed if performed in association with item 13203. This item excludes sperm preparation for ART using IVF. |
| 13251 | Nil. |
Recipient services
Billing MBS items for patients getting donated ova, sperm or embryos.
| MBS items | Item notes |
|---|---|
| 13209 | Nil. |
| 13215, 13218 | These items don’t include services provided for artificial insemination. |
Common billing errors and useful tips
You must provide the correct start date of a treatment cycle on Medicare claims or we may reject your claim. Here are some of the common reasons for rejected claims and useful tips.
‘Associated service already paid’ or ‘maximum number of services already paid’
This applies to items 13200, 13201, 13202, 13203 and 13218.
Check if the date of service is the first day of the treatment cycle. Each treatment cycle ends no more than 30 days after this date.
When the date of service of a subsequent global item is within 26 days of a previous global item, you can note ‘short cycle’ on the account.
Check the item descriptor. Item 13200 or 13202 are for the initial cycle in the calendar year. Item 13201 is for subsequent cycles.
‘No referral details’ or ‘associated service not claimed or IVF service conditions not met’
This applies to item 13209.
Check the referral details. Patients must be referred to a specialist for ART planning and management. You need to include current referral details on the account.
Check date of service is the date of the first day of treatment cycle. This is the same date as global treatment items 13200, 13201, 13202, 13203, and 13218.
‘Associated service not claimed’
This applies to items 13212, 13215 and 13221.
Check if the global item is present, either on the same account or previously paid.
Check the date of service. Each treatment cycle ends no more than 30 days after the date of the global item. Write ‘long cycle’ on the account for any item numbers that have a date of service 30 days or more after the global item.
Fertility cryopreservation
You can bill item 13260 for processing and cryopreservation of semen.
This item applies to post-pubertal patients referred by a specialist or consultant physician to preserve fertility when undergoing gonadotoxic treatment - radiation or chemotherapy. Reciprocal Health Care Agreements (RHCA) patients are eligible for this item.
A patient can have a maximum of 2 semen collection cycles. A cycle involves taking up to 3 semen samples on alternate days.
You should collect the:
- first cycle before the patient has the first cytotoxic or radiation treatment
- second cycle if the patient has relapsed and requires more treatment.
Item 13260 doesn’t cover ongoing storage costs of the sperm sample.