Medicare Benefits Schedule - Note TN.1.5

Item 13251 provides for intracytoplasmic sperm injection for male factor infertility under the following circumstances:

-           where fertilisation with standard IVF is highly unlikely to be successful; or

-           where in a previous cycle of IVF, the fertilisation rate has failed due to low or no fertilisation. 

Item 13251 excludes a service to which item 13218 applies.  Sperm retrieval procedures associated with intracytoplasmic sperm injection are covered under items 37605 and 37606. 

Items 13251, 37605, 37606 do not include services provided in relation to artificial insemination using the husband's or donated sperm.

Related Items: 13218 13251 37605 37606

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Preparation of frozen or donated embryos or donated oocytes for transfer to the uterus or fallopian tubes, by any means and including quantitative estimation of hormones and all treatment counselling but excluding artificial insemination services rendered in one treatment cycle and excluding a service to which item 13200, 13201, 13202, 13203 or 13212 applies

(Anaes.)

Fee: $904.00 Benefit: 75% = $678.00 85% = $805.30

(See para TN.1.4, TN.1.5 of explanatory notes to this Category)

Intracytoplasmic sperm injection for the purpose of assisted reproductive technologies, for male factor infertility, excluding a service to which item 13203 or 13218 applies

Fee: $476.15 Benefit: 75% = $357.15 85% = $404.75

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

Multiple Operation Rule

Transcutaneous sperm retrieval, unilateral, from either the testis or the epididymis, for the purposes of  intracytoplasmic sperm injection, for male factor infertility, excluding a service to which item 13218 applies.

(Anaes.)

Fee: $425.45 Benefit: 75% = $319.10 85% = $361.65

(See para TN.1.5, TN.8.58 of explanatory notes to this Category)

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: $631.75 Benefit: 75% = $473.85 85% = $537.00

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