Education guide - Billing assisted reproductive technology services

Information for specialists and fertility clinics about billing assisted reproductive technology (ART) services.

About the guide

This guide outlines the ART services covered in the Medicare Benefits Schedule (MBS). Make sure you read the relevant MBS item descriptors and explanatory notes at MBS Online before billing for any ART services.

ART services include a range of treatments to achieve pregnancy including:

  • in-vitro fertilisation (IVF)
  • gamete intrafallopian transfer (GIFT)
  • intracytoplasmic sperm injection (ICSI)
  • intrauterine insemination (IUI)

We pay Medicare benefits for clinically relevant services. ART services are clinically relevant when accepted by the medical profession as necessary to appropriately treat a patient’s medical infertility. Services performed must also comply with relevant state and territory laws.

Note that Reciprocal Health Care Agreement (RHCA) patients are not eligible for MBS ART services.

Treatment cycle

A treatment cycle is a series of treatments for ART services.

An ART treatment cycle starts on either:

  • the day the patient starts treatment with superovulatory drugs, or
  • the first day of the patient’s menstrual cycle, if not given superovulatory drugs

An ART treatment cycle ends no more than 30 days after the treatment cycle starts, or the day after the last: 

  • oocyte retrieval
  • transfer of embryos or both ova and sperm, or
  • preparation of sperm for artificial insemination

There is no limit on the number of ART treatment cycles a patient can have.

ART global items

Services provided as part of an ART treatment cycle are covered under ART global items and can’t be billed separately to Medicare.

The first day of the treatment cycle is the date of service for billing ART global items.

The following MBS items are global items:

  • 13200
  • 13201
  • 13202
  • 13203
  • 13206
  • 13218

These items cover all services related to an ART treatment cycle and include consultations, pathology, and diagnostic imaging services.

Medicare benefits are payable for services provided before the start of an ART treatment cycle and for services that don’t relate to the ART treatment cycle.

Please note that we may ask health professionals to verify in writing that non-ART services provided during the treatment cycle weren’t related to ART treatment.

Pathology and diagnostic imaging services

If you request pathology or diagnostic imaging services under an ART treatment cycle you should indicate on the request that the services are not eligible for a Medicare benefit.

If you receive a request for pathology or diagnostic imaging services from an ART clinic and you aren’t sure if they relate to a treatment cycle, contact the requesting practitioner for confirmation before billing for the services.

We pay Medicare benefits in accordance with the Health Insurance Act 1973 (the Act). Under subsection 129 AC (1), the Commonwealth may recover incorrectly paid Medicare benefits from the practitioner who provided the service, even if the benefit was not paid to them.

Embryology laboratory services

Embryology laboratory services for items 13200, 13201 and 13206 include:

  • egg recovery from aspirated follicular fluid
  • semen preparation
  • monitoring of fertilisation and embryo development
  • insemination, and
  • preparation of gametes or embryos for transfer or freezing

Surrogacy

You cannot use MBS ART items 13200 to 13221 for patients with surrogacy arrangements.

You can use item 13251 for patients with surrogacy arrangements when male factor infertility applies.

Surrogacy arrangements occur when a person:

  • agrees to become pregnant and to bear a child for another person, and
  • transfers guardianship and custodial rights to the other person at or shortly after birth

Billing for ART services

Billing MBS items for ART services

MBS items Brief description Billing date Item notes
13200 Initial cycle – superovulated treatment cycle proceeding to oocyte retrieval First day of treatment cycle Nil
13201 Subsequent cycle – superovulated treatment cycle proceeding to oocyte retrieval First day of treatment cycle You must have previously billed an item 13200 or 13202 in the same calendar year
13202 Superovulated treatment cycle – cancelled before oocyte retrieval First day of treatment cycle For an initial or subsequent cycle which is cancelled before oocyte retrieval
13203 Ovulation monitoring services for artificial insemination First day of treatment cycle Nil
13206

Natural treatment cycle, or treatment cycle where oocyte growth and development is induced using oral medication only

First day of treatment cycle

Provide in conjunction with item 13212

13209

Planning and management for treatment by:

  • ART, or
  • artificial insemination
First day of treatment cycle Bill with the same date of service as the appropriate global item (13200, 13201, 13202, 13203, 13206 or 13218)
13210 Professional attendance – telehealth via video conference First day of treatment cycle Bill in the same claim as item 13209 if performed.
13212 Oocyte retrieval for ART purposes Date service provided Provide in conjunction with 1 of the following items: 13200, 13201 or 13206
13215 Transfer of embryos, or both ova and sperm, to the uterus or fallopian tubes Date service provided Provide in conjunction with 1 of the following items: 13200, 13201, 13206 or 13218
13218 Preparation of frozen or donated embryos, or donated oocytes, for transfer to the uterus or fallopian tubes First day of treatment cycle Do not provide in conjunction with items 13200, 13201, 13202, 13203, 13206 or 13212
13221 Preparation of semen for artificial insemination Date service provided

Do not provide for IVF purposes

Provide in conjunction with item 13203
13251 Intracytoplasmic sperm injection for male factor infertility Date service provided

Do not provide with item 13203 or 13218 in the same treatment cycle.

Items 37605 and 37606 cover sperm retrieval procedures for intracytoplasmic sperm injection.

Items 13251, 37605 and 37606 don’t include services for artificial insemination

Billing for failed treatment cycle

Treatment cycle fails Cycle is MBS item billing
After oocyte retrieval Unsuccessful 13200 (initial cycle) or 13201 (subsequent cycle)
Before oocyte retrieval Incomplete 13202

MBS items for billing donor and recipient services

You must bill services for donated ova against the donor and not the recipient. You can only perform ART services on a donor if you have identified a medically infertile recipient. This is because under Medicare, a medically infertile recipient is a precondition for receiving ART services. Medicare benefits can only apply if there is a medical condition that requires treatment.

Donor services

Billing MBS items for patients donating their ova:

MBS items Item notes
13200, 13201, 13202, 13206 These items don’t include artificial insemination services
13209 Nil
13212  Nil
13221

For the preparation of sperm for artificial insemination. Can be billed if performed in association with item 13203

This item excludes sperm preparation for ART using IVF

13251 Nil

Recipient services

Billing MBS items for patients receiving donated ova, sperm or embryos.

MBS items Item notes
13209     Nil
13215,13218 These items don’t include services provided for artificial insemination

Common billing errors and useful tips

You must provide the correct start date of a treatment cycle on Medicare claims, or we may reject your claim. This table outlines some of the common reasons for rejected claims and useful tips.

Items Reasons for rejection Useful billing tips
13200, 13201, 13202, 13203, 13206, 13218

Associated service already paid

Maximum number of services already paid

Check the date of service is the first day of treatment cycle. Each treatment cycle ends no more than 30 days after this date. When the date of service of a subsequent global item is sooner than 30 days, you can note ‘short cycle’ on the account

Check the item descriptor. Item 13200 or 13202 are for the initial cycle in the calendar year. Item 13201 is for subsequent cycles

13209

No referral details

Associated service not claimed or IVF service conditions not met

Check the referral details. Patients must be referred to a specialist for ART planning and management. You need to include current referral details on the account

Check date of service is the date of the first day of treatment cycle. This is the same date as global treatment items 13200, 13201, 13202, 13203, 13206 and 13218
13212, 13215, 13221 Associated service not claimed

Check the global item is present, either on the same account or previously paid

Check the date of service. Each treatment cycle ends no more than 30 days after the date of the global item. When any of these item numbers have a date of service 30 days or more after the global item, you can note ‘long cycle’ on the account

More information

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Page last updated: 5 July 2018