CPT 89290 — Embryo Biopsy — 1–5 Embryos (PGT)
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.
What CPT 89290 Covers — The Embryology Lab Biopsy Component
CPT 89290 describes biopsy of oocyte polar body or embryo for preimplantation genetic testing (PGT) — covering 1 to 5 embryos. This code represents only the embryology laboratory work of extracting cells (typically trophectoderm cells from Day 5-6 blastocysts) for genetic analysis. For 6 or more embryos biopsied in the same session, use CPT 89291. One unit covers the entire biopsy session regardless of the number of cells extracted per embryo.
89290/89291 covers only the biopsy procedure itself. The genetic analysis performed by a third-party genetics laboratory is billed separately by that lab — typically using CPT 81228 (chromosomal microarray), 81229 (full genome microarray), or 81479 (unlisted molecular pathology). Fertility practices must never bill the genetics lab analysis on their own claim. Doing so constitutes duplicate billing and can trigger payer audits.
Code Selection: 89290 vs. 89291
| Embryos Biopsied | Code | Notes |
|---|---|---|
| 1 to 5 | 89290 | One unit covers all biopsy labor for up to 5 embryos. |
| 6 or more | 89291 | One unit covers biopsy of 6+ embryos in the same session. |
| Second biopsy session (re-biopsy) | 89290 or 89291 | Count embryos in that session independently. |
PGT Authorization — Three Distinct Entities
Prior authorization for PGT spans three entities: the IVF practice performing the biopsy (89290/89291), the genetics laboratory performing the analysis (separate contract), and the insurance payer who may cover one, both, or neither. Commercial payers have separate coverage policies for PGT-A, PGT-M, and PGT-SR. PGT-A is considered investigational by many commercial payers; PGT-M and PGT-SR have stronger coverage precedents with genetic counselor documentation.
- PGT-A (81228/81229): Frequently denied as investigational. Strongest clinical indications: advanced maternal age (38+), recurrent implantation failure (3+ failed transfers), recurrent pregnancy loss (2+ losses), prior aneuploid pregnancy. Reference ASRM PGT-A guidance in appeals.
- PGT-M (81401/81479): Stronger coverage with documented genetic counselor involvement, specific gene identification, and family history. Include genetic counseling report with authorization.
- PGT-SR (81479): Indicated for chromosomal rearrangements (translocations, inversions). Submit the affected partner karyotype with the authorization package.
Patient Financial Counseling Required
Before the PGT cycle, counsel patients that the embryo biopsy (89290/89291) may be covered by insurance while the genetics lab analysis is often self-pay. The genetics lab should provide a separate financial agreement. Without this coordination upfront, patients receive unexpected bills and dispute responsibility — creating collections problems for both parties.
Documentation for 89290
- Embryology lab report: number of embryos biopsied, biopsy technique (trophectoderm biopsy vs. polar body), blastocyst grades at time of biopsy
- Vitrification report confirming all biopsied embryos were frozen post-biopsy pending results
- Chain of custody documentation showing sample transfer to the reference genetics lab
- Prior authorization for both the biopsy (89290/89291) AND the genetics analysis if submitted to insurance
- ASRM-based clinical rationale supporting PGT indication for any payer requiring medical necessity documentation
Billing Notes
89290 covers biopsy of up to 5 embryos. For 6 or more embryos, use 89291. These codes reflect the embryology labor for biopsy only — the genetic analysis charges (81228, 81229, 81479) are typically billed directly by the genetics lab to the patient or payer.
Diagnosis Codes
Common Denial Reasons
- 89291 billed when embryo count is ≤5
- Biopsy and genetic analysis both billed by the clinic (split billing required)
- Missing documentation of embryo count biopsied
Payer Notes
Many commercial payers cover PGT-A for specific indications (advanced maternal age ≥38, recurrent miscarriage, prior aneuploid pregnancy). PGT-M and PGT-SR coverage requires strong prior authorization with genetic counseling documentation.
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