ASRM Egg Freezing Guidelines and the Billing Implications for Your Practice
ASRM's removal of the 'experimental' label from elective egg freezing changed what practices can bill — and what payers must cover. Here is how that guideline shift affects your billing workflows.
In 2012, ASRM removed the 'experimental' designation from oocyte cryopreservation — elective egg freezing — through a landmark Practice Committee opinion. That single guideline change had profound billing implications that are still working through the insurance industry more than a decade later. Understanding what ASRM said, why it matters for billing, and how payers have responded is essential for fertility practices that offer egg freezing services.
ASRM's Removal of the 'Experimental' Designation
Prior to 2012, oocyte cryopreservation was classified as experimental by ASRM, which gave payers a straightforward basis for coverage exclusion. ASRM's reclassification to 'established' practice was based on accumulating evidence that vitrification produced outcomes comparable to fresh embryo use. For billing purposes, the reclassification meant that payers could no longer rely on ASRM's own position as justification for experimental-service exclusions — a significant shift in the appeals landscape for egg freezing claims.
The Billing Shift That Followed
The reclassification did not automatically make egg freezing a covered benefit. Most commercial plans still exclude elective oocyte cryopreservation as a non-covered service — but the basis for denial shifted from 'experimental procedure' to 'not a covered benefit under this plan.' That distinction matters for appeals: a denial based on an experimental exclusion can be challenged with ASRM's established-practice designation; a denial based on a plan exclusion requires a different strategy (mandate compliance, benefit interpretation, or medical necessity for fertility preservation).
Elective vs. Medical/Oncofertility: A Critical Billing Distinction
ASRM guidance recognizes two distinct clinical scenarios for oocyte cryopreservation: elective preservation (the patient wants to defer childbearing) and medical preservation (the patient faces a condition or treatment that threatens future fertility, most commonly cancer). This distinction drives fundamentally different billing approaches — different ICD-10 codes, different benefit categories, different authorization pathways, and dramatically different coverage outcomes.
| Scenario | ICD-10 Code(s) | Coverage Outlook | Billing Notes |
|---|---|---|---|
| Elective egg freezing | Z31.84 (encounter for fertility preservation) | Typically excluded under commercial plans; some mandate states and fertility benefit managers cover | Confirm benefit before cycle. Most elective cycles are self-pay. Do not bill to major medical without confirmed benefit. |
| Oncofertility / medical preservation | Z79.890 (long-term use of hormone replacement therapy) + oncology primary dx; or C-code + Z31.84 | More frequently covered; some plans have specific oncofertility benefit language | Obtain authorization citing medical necessity. Include oncologist documentation of gonadotoxic treatment plan. |
CPT Codes for Egg Freezing and Storage
| CPT Code | Service | Billing Notes |
|---|---|---|
| 89337 | Cryopreservation, mature oocyte(s) | Bill once per cryopreservation session regardless of oocyte count. This is the primary procedure code for egg freezing. |
| 89342 | Storage per year; embryo(s) | Annual embryo storage — used when embryos are created. Not applicable for egg-only storage. |
| 89343 | Storage per year; sperm/semen | Annual sperm storage. Not applicable for egg freezing. |
| 89344 | Storage per year; reproductive tissue, testicular/ovarian | Annual storage for ovarian tissue — used in ovarian tissue cryopreservation, not standard egg freezing. |
| 89346 | Storage per year; oocyte(s) | Annual oocyte storage code. Coverage is rare; most patients pay out of pocket for annual storage. |
How Payers Have Responded to ASRM's Guidance Change
Payer responses to ASRM's reclassification have been inconsistent. A minority of commercial plans — primarily those operating in states with fertility mandates that explicitly include oocyte cryopreservation — now cover elective egg freezing. Fertility benefit managers like Progyny have been more responsive, incorporating egg freezing into their benefit structures. Most traditional commercial plans still exclude elective preservation but have updated their denial language to avoid citing 'experimental procedure' as the basis for denial, following ASRM's guidance change.
Documentation Requirements for Egg Freezing Claims
- Elective preservation: document the patient's informed consent, the clinical indication (elective), and the absence of gonadotoxic treatment — this establishes the billing scenario for the record.
- Oncofertility: obtain and retain the referring oncologist's documentation of the cancer diagnosis and planned gonadotoxic treatment. This is the core medical necessity document for insurance billing.
- Authorization: for any insurance-billed egg freezing, confirm that the authorization explicitly covers 89337 and lists the appropriate ICD-10 codes.
- Storage: document the number of oocytes stored and the storage start date. Annual storage billing (89346) requires this information and a patient consent to ongoing storage fees.
- Thaw cycle: when the patient returns to use stored eggs, the thaw (89354) and subsequent procedures require their own authorization and benefit verification.
ASRM Guidance as an Appeals Tool
When an egg freezing claim denies as 'experimental' — which still happens at payers with outdated policy language — cite ASRM's 2012 Practice Committee opinion reclassifying oocyte cryopreservation as established practice. This argument has been successful in reversing experimental-designation denials at multiple major commercial payers.
Egg freezing billing is a moving target — coverage is expanding slowly as payers update policies in response to ASRM guidance, mandate legislation, and employer benefit trends. Practices that maintain current benefit verification workflows, use ASRM guidance strategically in appeals, and clearly differentiate elective from medical preservation billing will consistently outperform those that treat egg freezing as a uniformly self-pay service.
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