Insurance Coverage for Tubal Reversal

Dr. Dan Martin has retired from clinical practice and moved to Richmond, Virginia. He can be reached at:

Endometriosis Concepts

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Insurance policies do not usually cover tubal surgery. They may cover some of the evaluation or testing before surgery without covering the surgery.

First check exclusions for:

  1. Infertility testing
  2. Infertility services and treatment
  3. Reversal of tubal ligation / tubal reanastomosis.

Then, if services are not excluded, ask if they cover

  1. Infertility testing ICD-10 code Z31.41
  2. Tubal infertility ICD-10 code Z97.1
  3. Past tubal ligation ICD-10 code Z98.51
  4. Tubal reversal CPT-4 code 58750

If you get an approval letter, read it carefully for exclusions.

Insurance company approval does not always mean the service is covered. The claim for an approved service can be denied if the service was excluded or otherwise not covered. Check for both exclusions and coverage.

Note: The old ICD-9 codes were:

  1. Infertility testing ICD-9 code V26.21
  2. Tubal infertility ICD-9 code 628.2
  3. Tubal reversal CPT-4 code 58750

Copyright 2016-2018

Updated September 21, 2018

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