Preimplantation Genetic Testing —
Biopsy, Analysis, and Transfer Billing
PGT billing involves at least two separate billing entities — the fertility clinic (embryo biopsy) and the reference genetics lab (chromosomal analysis). Getting the right codes, the right payer, and the right authorization for each component is the difference between payment and denial.
PGT Billing by Phase
Representative code examples only. Correct code selection depends on clinical documentation and payer contract terms.
Embryo Biopsy
89290 covers biopsy of 1–5 embryos. 89291 covers biopsy of 6 or more. These codes reflect the embryology labor component only — genetic analysis is billed separately, often directly by the reference lab.
PGT-A (Chromosomal Screening)
81228 is for comparative genomic hybridization (CGH) microarray; 81229 for whole-genome SNP microarray. Payer coverage varies significantly — most commercial plans cover PGT-A for recurrent miscarriage or advanced maternal age only.
PGT-M (Monogenic/Single-Gene)
PGT-M for known single-gene disorders uses 81479 (unlisted molecular pathology procedure) with supporting documentation. Prior auth is almost always required. Lab billing is typically direct-to-lab.
PGT-SR (Structural Rearrangements)
PGT-SR for balanced translocations or chromosomal inversions also uses 81479. Documentation must include the specific structural rearrangement and clinical indication.
Frozen Embryo Transfer (Post-PGT)
After PGT results, the FET cycle is billed with 58976 (frozen embryo transfer). S4017 is used for mandate payers tracking FET cycle utilization. Confirm authorization validity dates — PGT delays sometimes push the FET outside the auth window.
Diagnosis Code Scenarios
ICD-10 codes are illustrative. Final code selection requires clinical documentation review.
PGT-A — advanced maternal age (AMA)
PGT-A — recurrent pregnancy loss
PGT-M — known single-gene disorder
PGT-SR — balanced translocation
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