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CPT Code 58353 Billing and Coding Guide for Procedures on the Corpus Uteri

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Accurate coding for fertility procedures ensures timely reimbursement and compliance with payer policies. CPT 58353 represents intrauterine insemination (IUI) - a fertility treatment in which sperm is placed directly into the uterine cavity to increase the chance of conception.

This code is distinct from routine gynecologic procedures and requires precise documentation, as payer coverage for infertility services often varies.

CPT Code 58353 – Description of the Procedure

Official CPT Definition: “Insemination, intrauterine (AI, IUI); with or without preparation of sperm.”

This code is reported when a healthcare provider performs IUI, with or without sperm washing or preparation. The physician inserts a soft catheter through the cervix and injects the prepared sperm into the uterine cavity at or near the time of ovulation.

Although simple in duration, the procedure requires careful cycle timing, proper sperm handling, and documentation of medical necessity - especially when billing fertility-related services.

When to Use CPT 58353

CPT 58353 should be billed when the physician directly performs or supervises the intrauterine insemination procedure as part of a fertility treatment plan. Typical clinical reasons include:

  • Unexplained infertility after multiple natural cycles.
  • Mild male factor infertility (low motility or morphology).
  • Cervical factors preventing sperm passage.
  • Ovulation disorders under controlled stimulation.
  • Use of donor sperm or frozen sperm specimens.

You should not report this code for intracervical or intravaginal inseminations - in those cases, use CPT 58322. Similarly, embryo transfers related to IVF cycles are coded separately under CPT 58350.

Coding Guidelines and Billing Rules

  • Report 58353 once per insemination session, regardless of the number of sperm specimens used.
  • If an evaluation and management (E/M) service occurs on the same day (e.g., cycle counseling, medication adjustment), append modifier 25 to the E/M code.
  • Sperm preparation (washing, centrifugation) is considered a laboratory service, not part of this code.
  • Payers may classify IUI as part of infertility bundles - verify coverage before billing.
  • No global period applies; only the day of service is billable.
  • Typically performed in a fertility or OBGYN office; anesthesia is rarely required.

Reimbursement Overview

According to current payer data and Medicare fee schedules, the national average reimbursement for CPT 58353 ranges from $60–$120, depending on the setting and region.

Coverage for infertility services is highly variable - some insurance plans exclude IUI altogether, while others reimburse when linked to appropriate diagnosis codes such as:

  • N97.9 – Female infertility, unspecified
  • N46.9 – Male infertility, unspecified
  • Z31.83 – Encounter for assisted reproductive fertility procedure

Always verify benefits and prior authorization requirements before the procedure to prevent denials.

Modifier Use

Use the following modifiers where appropriate:

  • Modifier 25 – Append when an E/M visit is performed the same day.
  • Modifier 76 – Repeat IUI in the same cycle by the same physician.
  • Modifier 52 – Reduced service (e.g., procedure attempted but not completed).
  • Modifier 59 – Only if performed separately from another unrelated service.

Documentation Requirements

Clear documentation is critical for fertility-related services due to payer scrutiny. The medical record should include:

  • Diagnosis and infertility history.
  • Cycle details (natural, stimulated, donor, etc.).
  • Date and time of insemination.
  • Sperm source and preparation method.
  • Procedure description and any complications.
  • Patient counseling and follow-up instructions.

Thorough operative notes not only support compliance but also justify medical necessity - an essential factor for reimbursement in fertility care.

Example Scenarios

Scenario 1 – Partner Sperm IUI

A 32-year-old woman with two years of unexplained infertility undergoes ovulation monitoring. On the day of ovulation, the physician performs intrauterine insemination using washed partner sperm in the office. The patient tolerates the procedure well and is scheduled for follow-up.

→ Bill CPT 58353.

Scenario 2 – Donor IUI Under Stimulation Cycle

A patient receives ovulation induction medications and, following follicular monitoring, presents for insemination with thawed donor sperm. The procedure is completed without complication, and documentation confirms medical necessity under an infertility diagnosis.

→ Report CPT 58353.

Scenario 3 – Repeat Insemination Within Same Cycle

The patient undergoes two inseminations 24 hours apart within a single ovulatory cycle to optimize timing. The first insemination is billed as 58353; the second is also billed as 58353 with modifier 76 (repeat procedure by same physician).

These examples highlight how coding depends not just on the procedure but on the context, timing, and documentation supporting each insemination.

Why Choose BillingFreedom for OBGYN Billing

Procedures like intrauterine insemination require accurate coding, payer knowledge, and detailed documentation to ensure full reimbursement. That’s where BillingFreedom can make a difference.

We specialize in OBGYN medical billing services, offering certified coders who understand the unique complexities of fertility and reproductive billing. Our team ensures:

  • Clean claim submission with fewer rejections.
  • Accurate modifier use and diagnosis linkage.
  • Updated compliance with CMS and AAPC coding rules.
  • Faster payments and improved cash flow for your practice.

For more details about our exceptional OB/GYN medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472.

Your financial tranquility is our priority!

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