Fertility Billing
CPT Code Reference

Follicle puncture for oocyte retrieval, any method. This is the primary code for egg retrieval (oocyte pickup, OPU) in an IVF cycle. It covers aspiration of follicles using transvaginal ultrasound guidance.

Embryo transfer into the uterus using a fresh (never cryopreserved) embryo from the same stimulation cycle. This code applies when the embryo was cultured from oocytes retrieved in the current cycle and transferred without freezing.

Embryo transfer using a previously cryopreserved (frozen) embryo. This code applies to all frozen embryo transfer cycles regardless of when the embryo was frozen — whether from a recent freeze-all cycle or embryos in storage for years.

Artificial insemination by intrauterine injection. The most common insemination procedure — washed sperm is deposited directly into the uterine cavity via a catheter. Used for unexplained infertility, mild male factor, cervical factor, and as a first-line ART procedure.

Artificial insemination by intra-cervical injection. Less common than intrauterine insemination (IUI). The sperm sample is deposited at the cervical os rather than into the uterine cavity.

Culture of oocyte(s)/embryo(s), less than 4 days with oocyte identification from follicle aspiration. This code covers conventional fertilization and early embryo culture through Day 2 (cleavage stage).

Culture of oocyte(s)/embryo(s), 4 or more days with oocyte identification from follicle aspiration. This code applies when embryos are cultured to blastocyst stage (Day 5 or Day 6), which is standard practice in most modern IVF labs.

Assisted embryo hatching — mechanical, chemical, or laser thinning of the zona pellucida to facilitate embryo implantation. Performed before embryo transfer in select clinical scenarios.

Intracytoplasmic sperm injection (ICSI) for 10 or fewer oocytes. ICSI is the fertilization technique in which a single sperm is injected directly into an egg. The number of oocytes injected determines whether to use 89280 or 89281.

Intracytoplasmic sperm injection (ICSI) for more than 10 oocytes. This code applies when 11 or more mature oocytes are injected in a single cycle. It carries a higher reimbursement rate than 89280 to reflect the additional laboratory labor.

Biopsy of oocyte polar body or embryo for preimplantation genetic testing — 1 to 5 embryos. This code covers the embryology lab component of the biopsy procedure. Genetic analysis (chromosomal or molecular) is billed separately by the reference genetics laboratory.

Biopsy of oocyte polar body or embryo for preimplantation genetic testing — 6 or more embryos. The higher reimbursement vs 89290 reflects the additional embryology labor for biopsying larger cohorts.

Cryopreservation of embryo(s) — the freezing of one or more embryos for future use. Used for freeze-all IVF cycles, surplus embryos after fresh transfer, and PGT cycles where all embryos are frozen pending results.

Cryopreservation of mature oocytes (eggs). Used for elective fertility preservation, oncofertility cycles, and donor oocyte banking. This code is distinct from embryo cryopreservation (89258).

Thawing of cryopreserved embryo(s) in preparation for transfer. Billed at the time of the FET cycle, separately from the transfer code (58976).

Storage of embryo(s), by report. Annual cryostorage fee for embryos in long-term storage. Billed once per year per patient for ongoing embryo storage after the initial freezing cycle.

Sperm washing for use in artificial insemination. Covers sperm preparation techniques that separate motile sperm from seminal plasma, debris, and non-motile sperm — required before IUI to reduce risk of uterine cramping and improve sperm quality.

Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation. Reported in addition to 58970 (oocyte retrieval) when ultrasound guidance is performed and interpreted by the operating physician.

Bundled case-rate code for a complete IVF cycle, with or without ICSI — used by fertility mandate payers and fertility benefit managers (FBMs) to track cycle utilization against benefit limits. S4011 represents a complete cycle including egg retrieval and embryo transfer.

Complete IVF cycle, with 3 or more oocytes retrieved, but not meeting criteria for complete S4011 cycle. Used by mandate payers for tracking partial cycle counts where fewer embryos resulted from retrieval.

Frozen embryo transfer (FET) cycle case rate — used by mandate payers and FBMs to track FET cycle utilization. Submitted alongside CPT code 58976 for covered FET cycles.