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The California IVF Bill — What Fertility Clinics Should Know
The California IVF bill — SB 729 — was signed into law on September 24, 2025. It was originally scheduled to start July 1, 2025. Now it takes effect January 1, 2026.
The bill is a big shift in reproductive healthcare, with implications for IVF clinics, providers, and patients. It will improve access to fertility treatments for Californians by requiring insurance coverage for in vitro fertilization (IVF) procedures.
Understanding the California IVF bill’s details now will help clinics and providers maximize operations, stay compliant, and optimize billing practices as soon as the law takes effect.
This article breaks down California senate bill 729, aka the California IVF bill, and what it means, offers tips for IVF clinics and providers, and outlines strategies to manage billing and operations.
Key Takeaways of the California IVF Bill
- Requires large group health insurance plans cover IVF procedures and related fertility services on or after January 1, 2026.
- Starts coverage for CalPERS health plans on July 1, 2027.
- Includes artificial insemination, IVF, GIFT, and ZIFT.
- Includes coverage for LGBTQ+ individuals and couples, single parents, and others.
What Is the California IVF Bill?
The California IVF bill, or senate bill (SB) 729, requires large group health insurance plans with 101 or more employees to cover in vitro fertilization (IVF) procedures and related fertility services in new, renewed, or updated contracts or policies starting on or after January 1, 2026. It builds on California’s existing infertility coverage mandate that required coverage for certain fertility treatments but not IVF. The law expands access to IVF for patients who’ve struggled to afford the cost.
By requiring health insurers to include IVF in coverage, the bill will ease costs for people who need IVF to become parents but can’t pay for it out of pocket.
The law also makes the definition of infertility inclusive for LGBTQ+ individuals and couples, single parents, and others without fertility benefits who can benefit from IVF.
Key Provisions of the California IVF Bill
- Mandatory IVF coverage for the diagnosis and treatment of infertility and fertility services, including artificial insemination, IVF, GIFT, and ZIFT. The bill specifies coverage for up to three egg retrievals with unlimited embryo transfers and a single embryo transfer when recommended and medically appropriate. It also applies to medically necessary fertility preservation, such as for someone undergoing chemotherapy.
- Infertility defined as a licensed physician’s findings based on medical, sexual, or reproductive history, and being unable to conceive naturally after 12 months for people up to age 34 or six months if over 35; someone’s inability to reproduce alone or with a partner without medical help; and/or not being able to get pregnant or sustain a pregnancy naturally.
- The insurance contract can’t exclude, limit, or restrict coverage for fertility medications different from coverage for other medications; deny coverage for donor egg, sperm, or embryo, or use of a surrogate; or apply a deductible, copayment, maximum benefit, waiting period or other limit that’s higher or longer than for other coverage.
- Restricts discrimination for fertility medications or services based on age, gender, sexual orientation, or marital status.
The bill doesn’t apply to individual, small group, self-funded, level-funded, or religious employer insurance plans. It doesn’t require California’s Medicaid program, Medi-Cal or Medicare to cover IVF. It does require that small group plans offer at least one plan in the market that offers comparable infertility coverage to that required for large plans. Employers with fewer than 101 employees though don’t have to choose to offer an available plan with infertility coverage to employees.
The California Public Employees’ Retirement System (CalPERS) doesn’t have to comply with the law until July 2027.
How IVF Clinics and Providers Can Prepare
The California IVF bill creates opportunities and challenges for fertility clinics and providers.
Prepare for Increased Patient Volume
With IVF coverage mandated for large insurance plans, clinics and providers can expect an increase in patients looking for fertility treatments. Clinics and providers will want to ensure they have enough staff, equipment, and resources to treat more patients. They’ll also want to optimize scheduling, lab workflows, and patient communication if and as needed.
Revisit Insurance Contracts
To benefit from the new law, clinics and providers want to make sure they’re in-network with the insurance providers that will cover IVF if they’re not already. This may require working with insurers to establish fair reimbursement rates for IVF procedures. Clinics and providers also want to understand each insurer’s policies, including preauthorization requirements and patient eligibility criteria.
Prepare to Educate Patients
Patients may not understand their new insurance benefits under the IVF bill. Clinics and providers can help educate them the way they do for other procedures:
- Explaining eligibility requirements and how to access covered IVF treatments.
- Providing clear cost estimates, including out-of-pocket expenses for copayments and deductibles.
Be Prepared to Bill for IVF Services Under the Bill
The California IVF bill introduces new opportunities for clinics to bill insurance for procedures that were previously out-of-pocket expenses. To prepare for the California IVF bill clinics and providers want to understand billing codes. Key codes for IVF procedures include:
- CPT code 89261: Sperm prep for insemination
- CPT code 58322: Intrauterine insemination (IUI)
- CPT code 58974: Intrauterine embryo transfer
- CPT code 58970: Oocyte retrieval
- CPT code 89250: Culture and fertilization of oocyte(s)
- CPT code 89280: Intracytoplasmic sperm injection (ICSI)
- CPT code 89258: Cryopreservation of embryos
- CPT code 89342: Storage of embryos
- CPT code 89352: Thawing of cryopreserved embryos
- CPT code 89255: Preparation of embryo for transfer
- CPT code 89253: Assisted embryo hatching
Make sure your providers and billers stay up to date with coding changes and are trained on how to use them.
Challenges to Anticipate
While the California IVF bill brings positive changes, it also presents potential challenges.
Some insurers may impose restrictions, such as requiring patients to try less invasive treatments first. Your clinic or practice may need to navigate these requirements while also advocating for your patients.
As insurers adjust to the new law, there may be delays in claims processing. Your clinic or practice will want to closely monitor payments and quickly address issues. To help speed the process without added staff, consider an AI-based billing tool like the Azalea Health Billing Assistant that can automatically flags coding errors before submission and automates claim status tracking and save billers hours of manual work.
Bottom Line on the California IVF Bill
The California IVF bill marks a turning point for fertility care in California by expanding access to in vitro fertilization for many patients. It may also set a precedent for other states to follow. For IVF clinics and providers, it’s an opportunity to grow your practice and tap into new revenue while helping more people become parents.
To maximize clinic operations and billing success for the bill:
- Understand the bill’s provisions and insurance requirements.
- Understand CPT codes and optimize billing processes to ensure accurate and timely reimbursement.
- Enhance patient education and support to build trust and satisfaction.
Make sure your ambulatory EHR is specialty-practice friendly and supports fertility clinic-specific workflows.
Sources
California Legislative Information, SB-729 Health care coverage: treatment for infertility and fertility services. (2023-2024), https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240SB729
About the Author
Rian Faircloth is a healthcare technology and revenue cycle management professional at Azalea Health, where he drives business development and sales enablement for billing companies, VARs, and multi-clinic groups. He specializes in pricing strategy and client growth initiatives. Outside of work, Rian is an avid outdoorsman who enjoys fly fishing, boating, and tackling home improvement projects
