S4017 Ivf canc a stim case rateIncomplete cycle, treatment cancelled prior to stimulation, case rate
Status I: not valid for Medicare (Medicare uses another code).
7 of 7 payer prior-auth lists that name S4017 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Humana, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | FEP Standard Plan only | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Teamsters group (TYW) | AZ | prior auth required | Sep 1, 2026 | Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) | |
| Aetna | Commercial | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Medicare Advantage | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Humana | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management | ||
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth under conditions | not in NM, SC, WI | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 |
S4017 appears in 11 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Blue Shield of California, Centene, Cigna, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Infertility (0327) | covered if criteria are met | Jul 16, 2026 | payer document |
| Aetna | Invasive Prenatal Diagnosis of Genetic Diseases (0358) | listed, no stance (range S4011-S4022) | May 22, 2026 | payer document |
| Aetna | Preconceptional Sex Selection Techniques (0323) | listed, no stance (range S4011-S4042) | May 20, 2026 | payer document |
| Anthem | Assisted Reproductive Technology (CG-MED-103) | covered if criteria are met | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Expanded Fertility Services | covered if criteria are met | Dec 3, 2025 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Infertility Services | covered if criteria are met | Dec 3, 2025 | payer document |
| Blue Shield of California | | Reproductive Techniques (4.02.04) | listed, no stance | payer document | |
| Centene | Assisted Reproductive Technology (CP.MP.55) | covered if criteria are met | Feb 1, 2025 | payer document |
| Cigna | Infertility Services (0089) | not covered | Jun 15, 2025 | payer document |
| Premera Blue Cross | Infertility and Assisted Reproduction Services | listed, no stance | May 11, 2026 | payer document |
| UnitedHealthcare | Infertility Diagnosis, Treatment, and Fertility Preservation (2026T0270NN) | listed, no stance | Jun 1, 2026 | payer document |
Prior authorization required or conditional in IN.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.