2025 CPT code 89261
(Active) Effective Date: N/A Revision Date: N/A Laboratory Procedure - Reproductive Medicine Procedures Pathology and Laboratory Procedures Feed
Sperm isolation using complex preparation (e.g., Percoll or albumin gradient) for insemination or diagnosis, including semen analysis.
Modifiers may be applicable depending on the circumstances of service.Consult the CPT manual and local payer guidelines for appropriate modifier usage.
Medical necessity for 89261 is established when there is a clinical indication for assessing sperm quality and/or preparing sperm for assisted reproductive technologies (ART) such as IVF or ICSI.This may include cases of male infertility, suspected sperm abnormalities, or the need for sperm preparation for specific ART procedures.
Clinical laboratory personnel perform the technical aspects of sperm isolation and semen analysis.The ordering physician is responsible for medical decision-making and patient care related to infertility diagnosis and treatment.
In simple words: This lab test cleans and separates sperm from other fluids in a semen sample. This is done to prepare the sperm for use in procedures like in-vitro fertilization (IVF) or to check for problems with the sperm. The test also includes a standard semen analysis to look at the quality of the sperm.
This CPT code, 89261, encompasses the technical laboratory procedures involved in isolating sperm via complex preparation methods such as Percoll or albumin gradient techniques.The procedure is performed for either insemination (e.g., in vitro fertilization) or diagnostic purposes to identify sperm abnormalities.The code includes the comprehensive semen analysis (evaluating sperm count, motility, morphology etc.), thus eliminating the need for separate reporting of semen analysis codes (89300, 89310, 89320, 89321).The sample may be obtained through patient collection or clinician-assisted testicular aspiration (reported separately). The process involves separating sperm from seminal fluid components using centrifugation, often with repeated cycles for optimal purification.
Example 1: A male patient undergoing IVF treatment has a semen sample collected. The lab performs a complex sperm preparation (Percoll gradient) and semen analysis using code 89261 to prepare sperm for insemination., A male patient is suspected of having infertility issues.A semen sample is analyzed using 89261 to assess sperm quality and identify any potential abnormalities that may be contributing to the infertility., A couple is undergoing IVF. The male partner provides a semen sample. The laboratory uses code 89261 to prepare the sperm for ICSI (Intracytoplasmic Sperm Injection).The code includes the complete semen analysis required prior to ICSI.
* Patient demographics and identification.* Physician's order specifying the test (89261).* Date and time of semen collection.* Method of semen collection (patient or clinician-assisted).* Detailed description of the sperm preparation method used (e.g., Percoll gradient, albumin gradient).* Complete semen analysis results (volume, count, motility, morphology).* Any additional relevant clinical information.
** The density gradient methods (Percoll, albumin) mentioned are examples; the code applies to any complex sperm preparation technique.Billing practices may vary depending on payer policies and specific circumstances.Always consult current CPT guidelines and payer-specific instructions.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: This information is not available in the provided source. Consult your local payer's fee schedule for RVU values.
- Global Days: Not applicable. This is a laboratory procedure, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a laboratory procedure, not a surgical procedure with technical and professional components.
- Fee Schedule: This information is not available in the provided source.Consult your local payer's fee schedule for historical fee data.
- Specialties:Urology, Reproductive Endocrinology and Infertility, Clinical Laboratory
- Place of Service:Clinical Laboratory