`S4037` Cryo embryo transf case rate

Cryopreserved embryo transfer, case rate

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S4037

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S4037

11 of 11 payer prior-auth lists that name S4037 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Humana, Neighborhood Health Partnership, Oxford Health Plans, Surest, 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)
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Neighborhood Health Partnership	Neighborhood Health Partnership	FL	prior auth required		Sep 1, 2026	Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health Plans	Oxford Health Plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
Surest	Surest health plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Commercial	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
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
UnitedHealthcare	UnitedHealthcare West commercial plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare of the River Valley	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026

Payer coverage policies that name S4037

S4037 appears in 17 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	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
UnitedHealthcare	Preimplantation Genetic Testing and Related Services (CS160.N)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Preimplantation Genetic Testing and Related Services (for Kansas Only) (CS160KS.03)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Preimplantation Genetic Testing and Related Services (for Kentucky Only) (CS161KY.09)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Preimplantation Genetic Testing and Related Services (for Nebraska Only) (CS160NE.F)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Preimplantation Genetic Testing and Related Services (for New Mexico Only) (CS160NM.E)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Preimplantation Genetic Testing and Related Services (for Pennsylvania Only) (CS160PA.L)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Preimplantation Genetic Testing and Related Services (for Tennessee Only) (CS160TN.M)	listed, no stance	Jun 1, 2026	payer document

Recent prior-auth changes

Mar 1, 2026: PA removed, UnitedHealthcare
Sep 1, 2025: conditions changed, UnitedHealthcare
May 1, 2025: conditions changed, UnitedHealthcare
Dec 1, 2024: conditions changed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in IN.

ND: $0.00 (physician), effective Aug 1, 2026

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.

S4037 Cryo embryo transf case rate