CPT code 58970: Follicle puncture for oocyte retrieval

Learn how to properly use and bill for CPT code 58970 with our guide that comes complete with a list of documentation requirements and billing guidelines.

Use Code

What is CPT code 58970?

CPT code 58970 describes the surgical procedure of follicle puncture for oocyte (egg) retrieval - whether the patient's or donor eggs - regardless of the method employed. This procedure, done by qualified healthcare providers, is used for fertility treatment, more specifically in vitro fertilization (IVF) procedures.

This code represents the procedural component of assisted reproductive technology (ART).

CPT code 58970 documentation requirements

In order to support medical necessity and ensure accurate billing, the key elements that must be present in the patient's medical records are the following:

Patient's medical history
Pre-procedure evaluation
Indication for retrieval (e.g. in vitro fertilization)
Anesthesia/sedation used and route
Number of follicles aspirated and oocytes retrieved
Technique used (transvaginal ultrasound guidance)
Immediate complications or adverse events
Recovery status and post-op instructions
Medical necessity justification

CPT code 58970 billing guidelines

To avoid claim denials, the following specific guidelines for billing must be followed:

Bill once per procedure, regardless of the number of follicles or oocytes retrieved.
Modifiers are appended depending on the specific circumstances. Examples of applicable modifiers include modifier 26 (professional component), modifier TC (technical component), etc.
Check payer policies, as some may bundle the code with other related ART laboratory procedures.
Medicare generally doesn't reimburse fertility treatments. However, it may depend on specific circumstances or regional policies. It's best to consult Medicare Administrative Contractors (MACs) for guidelines.
Commercial payers' coverage, on the other hand, has specific criteria, dollar limits, or cycle limits. It's best to verify eligibility, benefits, and requirements prior to the procedure.

Other relevant CPT codes

89255: Preparation of embryo transfer
89250: Culture of oocytes/embryos, <4 days
58974: Embryo transfer, intrauterine

Frequently asked questions

Yes. CPT 58970 (Oocyte retrieval) is a billable procedure when performed according to clinical and documentation requirements.

You should still report 58970 if the retrieval procedure was performed and attempted, even if no oocytes were successfully retrieved.

Typically, anesthesia is included in the global surgical package and is not billed separately unless the payer allows it under specific circumstances.