Mar 2026: Is Infertility a Chronic Disease? Why This May Matter for Billing and Coding
Insights from the ASRM Coding Committee
When it comes to billing and coding for infertility services, one important question is making the rounds: should infertility be considered a chronic disease? This seemingly simple classification can have a significant impact on how reproductive medicine practices bill for patient visits.
Let’s break it down. According to the 2021 Current Procedural Terminology (CPT) guidelines developed by the American Medical Association (AMA), a chronic condition is defined as one lasting a year or more, requiring ongoing medical care, and potentially limiting daily activities. The CDC echoes this definition, describing chronic diseases as “conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.”
Infertility often lasts more than a year and nearly always requires frequent, ongoing treatment and management. It doesn’t fit the mold of an acute, short-term problem. In fact, both the World Health Organization (WHO) and the AMA recognize infertility as a disease. ASRM also defines infertility as a disease or condition characterized by an inability to achieve a successful pregnancy.
If infertility is classified as a chronic disease, clinicians can code for E/M visits based on medical decision making (MDM) and tap into additional billing options. For instance, chronic care management (CCM) CPT codes may apply, acknowledging the ongoing complexity of care. There’s also the add-on HCPCS code G2211, which compensates practitioners for the longitudinal, personalized care that chronic conditions demand, including infertility.
G2211 captures the extra time, expertise, and resources required for providers to coordinate and manage a patient’s long-term health needs, reflecting the true depth of their professional responsibility.
By considering infertility a chronic condition, practices can better reflect the complexity and continuity of care provided to patients. Remember, when using medical decision making for billing, it’s important to consider all relevant components, such as reviewing test results and medication management, as these factors can also increase the level of medical decision making.
Recognizing infertility as a chronic disease isn’t just about semantics - it’s about ensuring that patients receive the comprehensive care they need and that providers are compensated appropriately for their expertise and commitment.
If you have questions about optimizing your billing or coding practices for infertility-related visits, don’t hesitate to reach out to the ASRM Coding Committee for guidance. Please send additional questions to the e-mail address coding@asrm.org.
References:
When it comes to billing and coding for infertility services, one important question is making the rounds: should infertility be considered a chronic disease? This seemingly simple classification can have a significant impact on how reproductive medicine practices bill for patient visits.
What Is a Chronic Disease?
Let’s break it down. According to the 2021 Current Procedural Terminology (CPT) guidelines developed by the American Medical Association (AMA), a chronic condition is defined as one lasting a year or more, requiring ongoing medical care, and potentially limiting daily activities. The CDC echoes this definition, describing chronic diseases as “conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.”
Infertility: Chronic or Acute?
Infertility often lasts more than a year and nearly always requires frequent, ongoing treatment and management. It doesn’t fit the mold of an acute, short-term problem. In fact, both the World Health Organization (WHO) and the AMA recognize infertility as a disease. ASRM also defines infertility as a disease or condition characterized by an inability to achieve a successful pregnancy.
Implications for Billing and Coding
If infertility is classified as a chronic disease, clinicians can code for E/M visits based on medical decision making (MDM) and tap into additional billing options. For instance, chronic care management (CCM) CPT codes may apply, acknowledging the ongoing complexity of care. There’s also the add-on HCPCS code G2211, which compensates practitioners for the longitudinal, personalized care that chronic conditions demand, including infertility.G2211 captures the extra time, expertise, and resources required for providers to coordinate and manage a patient’s long-term health needs, reflecting the true depth of their professional responsibility.
Optimizing Your Billing Process
By considering infertility a chronic condition, practices can better reflect the complexity and continuity of care provided to patients. Remember, when using medical decision making for billing, it’s important to consider all relevant components, such as reviewing test results and medication management, as these factors can also increase the level of medical decision making.
Final Thoughts
Recognizing infertility as a chronic disease isn’t just about semantics - it’s about ensuring that patients receive the comprehensive care they need and that providers are compensated appropriately for their expertise and commitment.If you have questions about optimizing your billing or coding practices for infertility-related visits, don’t hesitate to reach out to the ASRM Coding Committee for guidance. Please send additional questions to the e-mail address coding@asrm.org.
References:
- https://urldefense.com/v3/__https://search.app/jqJtcL8v1FaDAS5AA__;!!H8mHWRdzp34!-6AQv_1sSNp2_5fwysYeXj3Yh-jQFzmbMHHo4Ga3UOzsBsIkQLIg_xBLKdnOwO_Xz7tlwmLuQ6dII8CV7gXRAQ$
- Bernell S, Howard SW. Use your words carefully. What is a chronic disease? Front Public Health. 2016; 4: 159.
- Practice Committee of the American Society for Reproductive Medicine. https://www.asrm.org/globalassets/_asrm/practice-guidance/practice-guidelines/pdf/definition-of-infertility.pdf
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