Medical Codes
ICD-10: N39.0
Urinary tract infection, site not specified
When there's more than one payer, ____ rules decide which one pays first
Coordination of Benefits
Empire_Ignacio P.
Is referral needed? Explain.
No. Because the plan is PPO.
Cigna_Zoe K.
What is the plan's copay for POS 11?
$40.00
Cryopreservation is covered based on the social reasons of the member
Elective
CPT: 36415
Collection of venous blood by venipuncture
Insurance plans subcontract a set of benefits to another plan of network; "third-party vendor"
Carved-Out Plans
Empire_Margot R.
When is the benefits renewal date?
Jan 01, 2026
Aetna_Natalie P.
What is the plan's coinsurance for POS 11?
40%
ART and related services are not covered
Not Applicable
HCPC: A0428
Ambulance service, basic life support, non-emergency transport
When insurance policy sets a cycle cap or limit to the amount they would cover for procedures related to a specific benefit
Cycle Restriction
BCBC_Elle F.
What is the policy renewal type?
Plan/Service Year
Aetna_Yvonne S.
How much is the Individual Deductible for this plan?
$1,500.00
Medical treatment may directly or indirectly cause infertility/sterility.
Iatrogenic
ICD-10: M54.5
Low back pain
A written order from the primary care doctor for a patient to see a specialist or get certain medical services
Referral
NYSHIP_Mandy M.
Does this plan follow the state mandate? Why?
Yes. Because it is fully insured.
Cigna_Amanda S.
How much is the Family Deductible for this plan?
$2,500.00
Preservation of eggs/embryo/sperm will be covered for a limited time only.
Cryo Consideration
CPT: 90658
Influenza virus vaccine
What are the three infertility mandates?
Mandate to Cover
Mandate to Offer
Non-participating
Aetna_Natalie P.
What is the plan's original effective date?
Jan 01, 2021
Oxford_Olivia W.
What is the plan's coinsurance for POS24?
0%
Cryopreservation will be covered based on the medical condition of the member or specific guideline of the plan.
Medical Necessity