Summary & Overview
CPT 0255U: Cap–Score™ Test, Sperm Capacitation Assay
CPT code 0255U designates the Cap–Score™ Test, a proprietary laboratory assay by Androvia LifeSciences that evaluates sperm capacitation and generates a probability score for achieving pregnancy. As a PLA code, 0255U applies exclusively to this single manufacturer’s test and signals a specialized diagnostic service in male fertility evaluation. The code matters nationally because it standardizes reporting for an emerging functional sperm assay that may inform fertility care pathways and laboratory billing practices.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and service delivery, payer coverage patterns where available, common modifiers used with the service, and benchmarking context for utilization and reimbursement when present. The publication also summarizes clinical context for capacitation testing, typical laboratory workflow, and implications for diagnostic coding and claims submission.
This report is organized to provide quick-reference benchmarks, policy and coverage notes, and clinical background to support billing and administrative decisions. Data not provided in the input (such as specific payer coverage policies, associated taxonomies, ICD-10 diagnoses, and related codes) are noted as unavailable where applicable.
Billing Code Overview
CPT code 0255U is a Proprietary Laboratory Analyses (PLA) code for the Cap–Score™ Test from Androvia LifeSciences, performed on a sperm specimen. The test triggers sperm capacitation, assesses ganglioside GM1 distribution patterns, and uses fluorescence microscopy to evaluate the percentage of capacitated sperm to generate a score indicating the probability of generating pregnancy.
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Service type: Laboratory test (proprietary sperm functional assay)
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Typical site of service: Clinical laboratory or reference diagnostic laboratory processing sperm specimens
Clinical & Coding Specifications
Clinical Context
A 34-year-old man and his partner present to a reproductive endocrinology and infertility clinic after 12 months of unsuccessful attempts to conceive. The male partner has normal external genital exam and semen analysis showing borderline motility. The clinician orders the Cap–Score™ Test to evaluate the sperm population’s ability to undergo capacitation and to estimate probability of achieving fertilization. A fresh or cryopreserved sperm specimen is collected in the andrology laboratory; capacitation is chemically induced and ganglioside GM1 distribution is assessed by fluorescence microscopy to generate a numeric Cap–Score™. Results are used by the fertility team to counsel regarding timing of insemination, selection of intrauterine insemination (IUI) versus in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI), or further male factor evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default / No modifier | Use when no special modifier applies and full global procedure reported |
26 | Professional component | Use when only the interpretive/physician component is billed separate from the laboratory technical component |