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Ovulation monitoring services for artificial insemination or gonadotrophin, stimulated ovulation induction, including quantitative estimation of hormones and ultrasound examinations, being services rendered during one treatment cycle but excluding a service to which item 13200, 13201, 13202, 13212, 13215 or 13218 applies

Fee: $567.75 Benefit: 75% = $425.85 85% = $482.60

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

Extended Medicare Safety Net Cap: $136.50

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Transfer of embryos or both ova and sperm to the uterus or fallopian tubes, excluding artificial insemination—only if rendered in connection with a service to which item 13200, 13201 or 13218 applies, being services rendered in one treatment cycle

Fee: $129.70 Benefit: 75% = $97.30 85% = $110.25

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

Extended Medicare Safety Net Cap: $61.40

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