Medicare Benefits Schedule - Note TN.8.59

Item 37606 covers open sperm retrieval for the purposes of intracytoplasmic sperm injection (item 13251) for male factor infertility, in association with assisted reproductive technologies. Item 37606 provides for the procedure to be performed unilaterally. Where it is clinically necessary to perform the service bilaterally, the multiple operation rule would apply. 

Benefits for item 37606 may be claimed in conjunction with a service or services provided under item 37605, where an open approach is clinically necessary following an unsuccessful percutaneous approach. Likewise, such services would be subject to the multiple operation rule. 

Benefit is not payable for item 37606 in conjunction with item 37604.

Related Items: 37606

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Multiple Operation Rule

Open surgical sperm retrieval, unilateral, including the exploration of scrotal contents, with our without biopsy, for the purposes of intracytoplasmic sperm injection, for male factor infertility, performed in a hospital, excluding a service to which item  13218 or 37604 applies.

(Anaes.)

Fee: $586.25 Benefit: 75% = $439.70 85% = $498.35

(See para TN.1.5, TN.8.59 of explanatory notes to this Category)