Washington Fertility Billing
& IVF Mandate Guide
New comprehensive mandate covering IVF, IUI, egg freezing, and fertility medications — significant billing volume expansion
What's Covered Under Washington's Mandate
Up to 3 IVF cycles; unlimited IUI. Always verify individual plan benefit designs at patient intake.
Up to 3 IVF cycles covered
Unlimited IUI cycles mandated
Covered for fertility preservation
Covered as part of IVF benefit
Mandated to be covered as part of infertility treatment
Covered when clinically indicated
Not mandated — verify per plan
Not mandated — payer discretion
Exempt from WA state mandate
Washington Billing Notes
The WA mandate took effect January 1, 2024. Payer prior auth workflows and benefit designs are still being finalized. Verify current requirements with each payer quarterly.
Premera Blue Cross and Regence BlueShield are the two dominant commercial payers in Washington. Both require prior authorization for IVF — submit clinical documentation at least 2–3 weeks before the planned start of stimulation.
Kaiser Permanente Washington is an HMO — IVF must be performed at an in-network Kaiser facility or with a Kaiser referral. Out-of-network ART claims will be denied.
Washington mandates fertility drug coverage. Coordinate billing of injectables between the practice and pharmacy benefit. Some payers require the medications to be billed under the medical benefit with CPT supply codes.
Top Payers in Washington
EasyRCM tip: Payer requirements change frequently. We track prior auth workflows, coverage criteria updates, and denial pattern shifts for every major payer in Washington — so you don't have to.
Washington Fertility Billing — FAQ
When did Washington's IVF mandate take effect?
Washington's fertility insurance mandate (SB 5765, RCW 48.43.0128) took effect January 1, 2024. Fertility practices in Washington should expect continued policy updates as payers finalize their benefit designs.
How many IVF cycles are covered in Washington?
Washington mandates up to 3 IVF cycles. Unlimited IUI cycles are also mandated, making Washington's law one of the more generous recent mandates.
Are fertility medications covered under Washington's mandate?
Yes. Washington mandates coverage for fertility medications as part of infertility treatment. This includes injectable stimulation medications and trigger shots used in IVF and IUI protocols.
Billing under Washington's mandate?
EasyRCM handles fertility billing for practices in Washington and all 21 mandate states — from eligibility verification and prior auth to denial appeals and A/R recovery.
Book Your Free WA Billing Review →