Policy: Assisted Reproductive Services/Infertility Services
Policy Number: 002
Last Update: 2020-07
Issued in: Massachusetts

This policy applies to Medicaid

Fertility Preservation:

In Vitro Fertilization (IVF) for Member not in Active Infertility Treatment

AllWays Health Partners covers one cycle of IVF for the purpose of egg retrieval, processing and fertilization and a single cryopreservation of eggs/embryos for up to one year, when there is documentation that a member will be undergoing medical or surgical treatment (e.g. chemotherapy, radiation, gender affirming treatment), that is likely to result in permanent infertility.

Cryopreservation of Eggs/Embryos

[Female-assigned] member will be undergoing medical or surgical treatment (e.g. chemotherapy, radiation, gender affirmation etc) excluding voluntary sterilization that is likely to result in permanent infertility, and AllWays Health Partners has authorized an IVF cycle for stimulation and retrieval. Cryopreservation of eggs/embryos will be covered for up to one year from the time of the egg retrieval.

Cryopreservation of Sperm

[Male-assigned] member will be undergoing medical or surgical treatment (e.g. chemotherapy, radiation, gender affirmation ) excluding voluntary sterilization that is likely to result in permanent infertility. In this case the male member and/or couple do not need to be already receiving AllWays Health Partners -authorized in infertility services. There must be a >5% probability of a future live birth using the member’s cryopreserved sperm.