Summary & Overview
CPT 0552U: Preimplantation Genetic Testing for Monogenic Disorders (PGT–M)
CPT code 0552U is a Proprietary Laboratory Analyses (PLA) code that uniquely identifies Igenomix®’s preimplantation genetic testing for monogenic disorders (PGT–M). The assay evaluates trophectoderm biopsy samples using linkage analysis and, when applicable, targeted mutation testing to determine whether embryos are low–risk or high–risk for a known familial genetic disorder. This code matters nationally as precision reproductive genetic testing becomes more integrated into assisted reproductive technology and payer coverage decisions influence patient access and laboratory utilization.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for PGT–M, payer coverage landscape, coding specifics for a PLA test, and operational benchmarks relevant to billing and claims processing. The publication also summarizes common modifiers associated with laboratory services and highlights areas where policy updates or clarification from payers may impact claim adjudication. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service-line specifics are noted as unavailable where applicable.
Billing Code Overview
CPT code 0552U is a Proprietary Laboratory Analyses (PLA) code for preimplantation genetic testing for monogenic/single gene disorders (PGT–M) offered by Igenomix®, part of Vitrolife Group™. The test screens embryos for known inherited genetic disorders prior to implantation using a trophectoderm biopsy and linkage analysis; when the family has a known mutation, targeted mutation analysis may be performed. Results indicate whether an embryo is low–risk or high–risk for the specified disorder.
Service type: Genetic diagnostic laboratory test (proprietary PGT–M service)
Typical site of service: Reproductive endocrinology / IVF clinic with specimen processing at a specialized molecular genetics laboratory
Clinical & Coding Specifications
Clinical Context
A 34-year-old couple with a known autosomal dominant mutation seeks in vitro fertilization (IVF) with preimplantation genetic testing for monogenic disorders (PGT–M) through Igenomix® (Vitrolife Group™). The couple undergoes ovarian stimulation, oocyte retrieval, fertilization (ICSI), and embryo culture to the blastocyst stage. At day 5–6, a trophectoderm biopsy is performed on suitable blastocysts and embryonic cells are sent to the Igenomix® laboratory for analysis using linkage-based targeted mutation testing. The laboratory report categorizes each embryo as low–risk or high–risk for the familial disorder to inform embryo selection for transfer.
Typical site of service: outpatient fertility clinic or ambulatory surgical center for oocyte retrieval and embryo biopsy; reference laboratory (Igenomix®) for the proprietary PLA test.
Service type: Proprietary Laboratory Analysis (PLA) — specialized genetic diagnostic testing performed by a single manufacturer/lab for embryo risk assessment prior to implantation.
Typical patient workflow:
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Initial genetic counseling and carrier/diagnostic testing for parental mutation
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Ovarian stimulation, oocyte retrieval, and ICSI in an outpatient fertility center
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Embryo culture to blastocyst and trophectoderm biopsy in the embryology lab
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Shipment of biopsy specimen to Igenomix® and performance of the proprietary linkage-targeted mutation assay (
0552U) -
Receipt of results indicating low-risk or high-risk embryos and counseling to guide embryo transfer decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity of specimen handling, documentation, or counseling for testing is substantially greater than typical |
52 | Reduced services | Use when testing is partially reduced or curtailed (for example, incomplete analysis) but not fully cancelled |
53 | Discontinued procedure | Use when the biopsy or specimen collection was started but discontinued for reasons unrelated to patient improved condition |
59 | Distinct procedural service | Use if a separate unrelated service was performed on a different specimen or encounter the same day |
26 | Professional component | Use when billing only the interpreter/professional component of the laboratory result (if applicable in local policy) |
TC | Technical component | Use when billing only the technical component of the test when the lab performs analytic work but not interpretation |
90 | Reference (outside) lab | Use when specimen analysis is performed by an outside laboratory (may apply when sending to Igenomix®) |
91 | Repeat clinical diagnostic laboratory test | Use when the test is repeated on the same day for confirmation |
KX | Requirements specified in the medical policy are met | Use when test-specific payer policy has prerequisites that are satisfied (payer-specific modifier) |
JW | Drug/biological amount discarded/not administered | Rarely applicable; use only if associated biologic specimen or reagent waste must be documented |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Reproductive Endocrinology/Infertility | Physicians who coordinate IVF cycles, retrievals, and embryo transfer |
| 2084P0800X | Clinical Genetics | Medical geneticists who determine inheritance risk and test indications |
| 3336S0002X | Laboratory Genetic Testing | Laboratory directors and directors of molecular diagnostics overseeing PGT testing |
| 208000000X | Obstetrics & Gynecology | OB/GYNs involved in fertility treatment and patient counseling |
| 206RH0000X | Reproductive Endocrinology (non-physician) | Advanced practice providers assisting in IVF care |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z31.84 | Encounter for assisted reproductive fertility testing and counseling | Indicates patient undergoing fertility services including IVF and PGT procedures |
Z31.83 | Encounter for assisted reproductive technology cycle | Used for encounters involving IVF cycles that include embryo biopsy and testing |
Z36.0 | Encounter for antenatal screening for chromosomal disorders in fetus | Related screening context for genetic testing of embryos, guiding risk assessment |
O35.2XX0 | Maternal care for (suspected) genetic condition in fetus, unspecified trimester, fetus unspecified | Used when parental known genetic mutation prompts prenatal/embryonic testing consideration |
Z15.09 | Genetic susceptibility to other malignant neoplasm | Example of a hereditary condition (if applicable) that may motivate PGT–M to avoid transmission |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
89260 | Embryo biopsy, zona pellucida intact, with embryo preservation | Performed when obtaining trophectoderm cells for PGT–M prior to shipment to the lab |
89250 | Micromanipulation; assisted hatching, per embryo | Often performed in conjunction with embryo handling in IVF cycles though not required for biopsy |
58970 | Oocyte retrieval, any technique | Performed earlier in the IVF cycle to obtain oocytes that will be fertilized and develop into embryos for biopsy |
89258 | Embryo thawing; for embryo transfer | May be performed before transfer of a cryopreserved embryo that was tested with 0552U |
89280 | Embryo transfer, intrauterine | Final procedural step after selection of a low–risk embryo identified by the PGT–M assay |