Aetna US Healthcare (AUSHC)
Most plans require authorizations from the AUSHC Infertility Hotline. AUSHC will not allow RMA of NJ to obtain authorizations for our patients. The patient must call the hotline for authorization for all covered services, not just the initial visit.
On occasion, there are some policies that will require a PCP referral instead of an infertility line authorization. Most PCP's will automatically issue a referral using procedure code 99499 (testing and treatment). Note: This code does not cover ultrasounds, blood work or andrology services.
At your initial consultation at RMA of NJ, a comprehensive ultrasound is usually performed. In order to have an ultrasound on your initial consult please make sure your PCP uses the following codes so we can ensure we can perform the service at your initial visit:
| Initial Consultation or visit: |
99245 or 99205 |
| Comprehensive Ultrasound: |
76856 |
The blood work that will also have to be done is called "Day Three Labs" and the codes for those services are as follows:
| Estrodial : |
82670 |
| Progesterone: |
84144 |
| Follicule Stimulating Hormone (FSH): |
83001 |
| Luthenizing Hormone (LH) : |
83002 |
| Beta HCG: |
84702 |
If you have questions about coding, please contact the RMA of NJ Finance Department.
Male partners are not required to use the infertility hotline and they are not covered under the patient authorizations. They must obtain a PCP referral for any services rendered at RMA of NJ Commonly used codes include:
| Semen Analysis: |
89320 |
| Anti-Sperm Antibody: |
89325 |
| Diagnosis Code: |
V26.21 |
AUSHC Tips:
If you have an inappropriate referral, you will be given the option of rescheduling or paying at the time of service. If you try to obtain a corrected referral, it must be done before the service is provided because AUSHC referrals cannot be backdated. AUSHC requires that you use Freedom Drugs or Chonimed for all injectable medications.
