Aetna IVF coverage policy: step therapy, PGT-A, and what gets denied (2026)
Policy: Clinical Policy Bulletin 0327 — Infertility. This is the clinical policy your clinic's authorization team is arguing against. Knowing it before you start avoids the most common denials.
Step therapy (IUI before IVF)
Required. Requires a trial of ovulation induction / intrauterine insemination (typically 6–12 months or a defined number of IUI cycles) before IVF unless a bypass indication is documented.
Bypass criteria:
Age 38 or older
Bilateral tubal factor / tubal occlusion
Stage III–IV endometriosis
Severe male factor infertility
Prior failed IUI cycles per policy count
Ovarian reserve and age thresholds
Day-3 FSH below 19 mIU/mL required for coverage of stimulation cycles
Considered experimental / not medically necessary
PGT-A for IVF optimization (without a hereditary-disease indication)
Endometrial receptivity analysis (ERA)
ICSI without male-factor diagnosis
Sperm DNA fragmentation testing
Elective (non-medical) retrieval, freezing, and/or storage of oocytes or sperm, and creation/freezing/storage of embryos, to circumvent reproductive aging in healthy persons
Post-coital testing
Prior authorization required for
Each IVF cycle
Medications via specialty pharmacy
FET
Billing quirks that cause denials
Ultrasound guidance (76948) bundled into retrieval
Uses HCPCS S-code mapping tool for global IVF billing
Appeal tips
If age 38+ or a bypass diagnosis applies, cite the specific CPB 0327 bypass language and attach the diagnosis documentation.
For PGT-A denials, expect 'experimental' — external review is possible on medical-judgment grounds, but success is limited; consider whether the clinic can document a hereditary indication.
Request the specific policy section relied upon in the denial letter (ACA requires disclosure).
Free, 5 steps, nothing saved unless you choose to.
Verification notes: Aetna CPB 0327 shows Last Review 07/16/2026 (next review 05/25/2027); Aetna CPBs carry a last-review date rather than a formal effective date, so effective_date reflects the last review. Re-confirmed 2026-09-06 directly against the live CPB page AND its linked revision-history popup (aetna.com/cpb/medical/data/disclaimer/review/300_399/0327_77.html, titled 'Revision Info - 07/16/2026') — date unchanged from the prior verification, but the revision-history text was read this pass and it describes real content changes as of 07/16/2026 that weren't previously captured here: (1) terminology change from 'cryopreservation of mature gametes/embryos' to 'retrieval, freezing, and/or storage of oocytes or sperm; and creation, freezing, and storage of embryos'; (2) elective/social fertility preservation 'to circumvent reproductive aging in healthy persons' is now explicitly experimental/investigational/unproven — added to considers_experimental; (3) post-coital testing is now explicitly experimental/investigational/unproven — added to considers_experimental; (4) growth hormone, ACTH, estrogens, and 17-hydroxyprogesterone were REMOVED from the medically-necessary male-infertility workup list; (5) androgen (testosterone) therapy was REMOVED as a medically-necessary treatment for male infertility. Items (4)-(5) are noted here as a flag for anyone building male-factor-specific content — this file has no field for a 'no longer medically necessary' list, so they aren't represented elsewhere in this record. Verified quotes on 2026-09-06: day-3 FSH 'must be less than 19 mIU/mL' (most recent test under 40; all prior tests at 40+); IUI trial before IVF — under 35: '12 months of regular intravaginal inseminations or 4 cycles of timed intrauterine or intracervical inseminations'; 35 and older: '6 months ... or 3 cycles'; waived where inseminations 'would not be expected to be effective'. PGT-A and endometrial receptivity testing remain experimental/investigational.
This page explains public coverage rules and typical prices as of the dates shown. It is an estimate and an interpretation, not a coverage decision by your plan, and not legal, medical, tax, or insurance advice. Your plan documents control. We never store what you enter here unless you choose to save a plan.