Prior Authorization
Humana Prior Authorization for CPT 58970
Infertility diagnostic and treatment services · Standard commercial plans
Source
Data pending source-document linkage. Verify against Humana's current clinical policy before submission.
Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Infertility testing and treatment
Documentation checklist
- ✓Clinical notes
2026 Medicare rate for CPT 58970
Office (non-facility)
$237.15
Facility
$172.68
Total RVUs (office)
7.10
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 58970 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT 58970?
- Yes. Humana requires prior authorization for CPT 58970 (Infertility diagnostic and treatment services) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 58970?
- Clinical notes
- How much does Medicare pay for CPT 58970 in 2026?
- In 2026, the national Medicare allowable for CPT 58970 is $237.15 in an office setting and $172.68 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 58970?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Humana PA lookups
CPT 58970 prior authorization by payer
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