Patient Information: Evaluation for RPL

Welcome to the Center for Recurrent Pregnancy Loss at Pacific NW Fertility. Our mission is to provide personalized and appropriate care for patients with a history of multiple miscarriages. The first step to your care is an evaluation specific to your personal history. We list the recommended tests below with the appropriate diagnostic codes. We encourage you to review these with your insurance provider to understand if you may incur any out of pocket costs for the evaluation and to review if referral or pre-authorization is recommend/required before testing.

When ready to proceed with testing, please let us know so we can review which tests we are ordering and help you plan for testing on the appropriate days of you cycle since the SIS is done on cycle day 5-10 and the ovarian reserve testing blood work is done on cycle day 3. You do not need to be fasting for any bloodwork.

Female Patient:

Test Reason ICD 10 Code CPT Code Approximate cost*
Saline infusion sonogram (SIS) Uterine cavity evaluation N96 58340 & 76831 $780.00
FSH Ovarian reserve testing N96 83001 $78.00
Estradiol Ovarian reserve testing N96 82670 $83.00
AMH (Anti-Muellerian hormone) Ovarian reserve testing N96 83520 $85
Karyotype - screening for chromosome issues associated with RPL Genetic testing Z31.438 88291, 88262, 88230 $330.00
TSH (thyroid stimulating hormone) Thyroid screening Z13.29 84443 $75.00
TPO Ab (Antibodies to thyroid peroxidase) Thyroid screening Z13.29 86376 $50.00
Prolactin Hormone screening Z13.29 84146 $81.00
HbA1C (hemoglobin A1C) Diabetes screening Z13.1 83036 $177.00
Lupus anticoagulant (Antiphospholipid syndrome) Autoimmune screening Z31.0 85613 $233.00
ACLA IgG and IgM (Anticardiolipin antibodies/Antiphospholipid syndrome) Autoimmune screening Z13.0 86147 $275.00
Beta-2-glycoprotein IgG and IgM (Anticardiolipin antibodies/Antiphospholipid syndrome) Autoimmune screening Z31.0 86146 $90.00
Blood type Prenatal screening Z01.83 86900 $30.00
Rubella titer Prenatal screening Z11.59 86762 $30.00
Varicella titer Prenatal screening Z11.59 86787 $63.00
Fee for blood draw 36415 $25.00

Male Patient:

Test Reason ICD 10 Code CPT Code Approximate cost*
Karyotype (chromosome analysis) Genetic testing - for a chromosome issue associated with RPL Z31.441 88291, 88262, 88230 $333.00
Fee for blood draw 36415 $25.00
Semen analysis Z31.41 89320 $120.00

*Prices are approximate and may change based on where testing done, insurance coverage, and at a later time than 1/2018

I have been extremely impressed and grateful for the level of care and service I have received from PNWF. Everyone has been caring, professional and helpful throughout my process. The calm and matter-of-fact demeanor of my nurse has been calming when I have been unsure of what to do or impatiently waiting a result. The day of the transfer went very smoothly and I would recommend PNWF to anyone going through  this process. Thank you for everything.

Anonymous
Pacific NW Fertility Patient

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