CPT S4042: How to Maximize Revenue With S-Codes & Procedure Combos

What is CPT S4042?

CPT S4042 is a medical billing code responsible for covering the time physicians spend coordinating cycle care plans and organizing tests outside of face-to-face visits. 

In particular, medical billers can add CPT S4042 to ovulation induction cycles, including intrauterine inseminations (IUIs) and oocyte retrievals.

You can also use the code to bill for cycles that are canceled before retrieval or when patients come to your clinic for monitoring while having induction procedures performed at another clinic.

Read More: The Medical Billing Process 101: Everything You Need to Know

What is CPT S4042’s Reimbursement Value?

This code, which most insurance providers cover, has a national average reimbursement of $500 per cycle.

How Many Times Can You Use S4042?

You can bill S4042 consecutively when patients undergo multiple cycle treatments to achieve a mature follicle. Billing is limited to once per month/cycle up to a maximum of twelve cycles per year.

Read More: The Impact of Technology on Medical Billing: Automation and Efficiency

Why Is CPT S4042 So Important?

Unfortunately, insurance coverage of fertility services is spotty. Most insurance plans only cover evaluations and diagnostics, if they cover anything at all. Unless a patient works at a company with over 20,000 employees, her fertility treatments will probably remain uncovered by insurance.

That makes every CPT code you can use incredibly valuable. Because of its high usability, CPT S4042 helps ensure patients keep returning for treatment until achieving a successful pregnancy.

What is Ovulation Induction?

According to the National Center for Biotechnology Information, about 25% of infertility is caused by ovulatory disorders. These women either experience irregularities in their ovulation or no ovulation at all. 

To combat this issue, infertility specialists often use ovulation induction to stimulate egg development and increase the chance of pregnancy. Through fertility medications, ovulation induction helps develop mature follicles in the ovaries and promotes the release of more than one egg without surgical intervention.

As a go-to solution for infertility, this makes the S4042 code especially useful for fertility clinics like yours.

Remote Medical Billers: The Solution To Coding Inefficiencies

Remote medical billers are a perfect fit for practices that are overwhelmed by the medical coding system. Unlike traditional in-house billers, who are often inefficient and expensive, a remote billing team that understands the intricacies of medical coding will take care of everything while you focus on delivering care for your patients.

Solve Your Medical Coding Shortcomings With DrCatalyst

Remembering, managing, and recording medical billing codes in-house isn’t just complicated and expensive—it’s unnecessary. At DrCatalyst, we can handle all your billing needs for a fraction of the cost.

Our team of talented remote billing experts knows how to navigate the nuances of medical billing, including coding, charge posting, accounts receivable, eligibility verification, appeals, and more. In as little as six months, DrCatalyst clients see a 20% decrease in outstanding balances and a 20% increase in revenue.

When you partner with DrCatalyst, your practice can expect rapid scalability, massive cost savings, globally sourced talent, reduced appeals and denials, and improvements to your accounts receivable. As an organization based on accountability and transparency, we not only provide regular revenue and productivity reports but assign a personal account manager to create a customized solution that addresses your specific needs.     

Whether you need specialized billing help or comprehensive revenue cycle management, we’ll turn your slow and inefficient income streams into the positive cash flow you deserve. Contact our team now and try DrCatalyst risk-free!