CPT 0554U Smart PGT–SR Reimbursement & Policy

Headline: New CPT code 0554U identifies a proprietary comprehensive chromosomal analysis for IVF embryos

Lead: CPT code 0554U designates the Smart PGT–SR proprietary laboratory test used to assess all 24 chromosomes in trophectoderm biopsies of in vitro fertilization (IVF) embryos, reporting aneuploidy, abnormal ploidy, mosaicism and a mitochondrial DNA score with accompanying quality control data.

CPT code 0554U represents a PLA code tied to a unique manufacturer-specific test (Igenomix®/Vitrolife Group™ and Thermo Fisher Scientific). Nationally, this code matters because it standardizes billing for an advanced reproductive genetics service that informs embryo selection during IVF. Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of the clinical purpose and lab workflow behind the code, coverage and payer considerations, common claim modifiers, and benchmarking context where available. The publication summarizes what the code measures (24-chromosome analysis from trophectoderm biopsy, mitochondrial DNA scoring, and quality control reporting), typical service setting (reproductive medicine and specialized fertility laboratories), and the relevance of proprietary PLA coding for billing consistency and payer policy alignment. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 0554U is a Proprietary Laboratory Analyses (PLA) code for the Smart PGT–SR test offered by Igenomix®, part of Vitrolife Group™, and Thermo Fisher Scientific. The test analyzes 24 chromosomes from a trophectoderm biopsy of an in vitro fertilization (IVF) embryo to detect chromosomal abnormalities such as aneuploidy, abnormal ploidy (for example, triploidy or haploidy), and mosaicism. The service also provides a mitochondrial DNA score and includes quality control results to support test accuracy.

Service type: Genetic/embryo chromosomal analysis for IVF embryos.

Typical site of service: Reproductive medicine laboratories and specialized fertility clinic-associated laboratories performing embryo biopsy and sequencing-based testing.

Clinical Context

A 35-year-old patient undergoing in vitro fertilization (IVF) elects to have comprehensive chromosomal screening of blastocyst-stage embryos prior to transfer. During the IVF cycle, embryos reach the blastocyst stage and a trophectoderm biopsy is performed by the embryology team to collect a small number of outer-layer cells. The specimen is sent to the laboratory performing the proprietary Smart PGT–SR test (0554U) to assess all 24 chromosomes for aneuploidy, abnormal ploidy (for example, triploidy or haploidy), and mosaicism. The report also includes a mitochondrial DNA score and quality control metrics. Typical workflow steps: embryo biopsy in the assisted reproductive technology (ART) clinic or IVF laboratory; specimen labeling and shipment under chain-of-custody procedures to the performing lab; laboratory processing, sequencing/analysis, and bioinformatic interpretation; electronic delivery of results to the ordering reproductive endocrinologist and genetic counselor; incorporation of results into embryo selection counseling and the decision for transfer, cryopreservation, or disposal. Typical site of service: outpatient fertility clinic, IVF laboratory, or the performing reference molecular genetics laboratory.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/no modifier	Use when no special reporting modifier applies; standard service reporting.

Taxonomy Code	Specialty	Notes
207Q00000X	Reproductive Endocrinology and Infertility	Ordering clinicians who manage IVF cycles and embryo selection.
208U00000X	Clinical Laboratory Genetic Services (Laboratory Director)	Laboratory directors responsible for genetic testing oversight.
2086S0105X	Molecular Genetics Laboratory	Performing laboratory specialty that runs sequencing and analysis for PGT.
207L00000X	Obstetrics & Gynecology	Fertility specialists within OB/GYN practices who coordinate IVF care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N97.9`	Female infertility, unspecified	Common indication for IVF and preimplantation genetic testing when infertility is the primary diagnosis.
`N97.0`	Female infertility due to tubal origin	Tubal factor infertility leading to IVF and embryo testing to optimize transfer outcomes.
`N97.1`	Female infertility due to ovulatory dysfunction	IVF cycles with embryo selection may use PGT to reduce transfer of aneuploid embryos.
`N97.8`	Female infertility due to other specified causes	Includes mixed or less common causes prompting IVF and embryo chromosomal screening.
`Z31.41`	Encounter for assisted reproductive fertility procedure cycle, IVF	Encounter code used during the IVF cycle when embryos are created and biopsied for testing.
`Z31.42`	Encounter for assisted reproductive technology cycle, donor oocyte	Relevant when donor oocytes are used and embryos undergo PGT analysis.
`Z13.79`	Encounter for screening for other genetic and chromosomal anomalies	Screening context for genetic evaluation of embryos prior to transfer.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`89250`	Embryo biopsy, micromanipulation, and blastocyst biopsy (trophectoderm)	Performed by the IVF embryology team to obtain the specimen analyzed by `0554U`.
`88384`	Surgical pathology, gross and microscopic examination when provided (molecular pathology interpretive services may be billed separately when applicable)	Not typically billed for PGT but may apply if a pathology service documents specimen handling; included here as ancillary specimen interpretation when applicable.
`81479`	Unlisted molecular pathology procedure	Occasionally used for reporting novel or unlisted molecular tests when PLA codes are not available; not for use when `0554U` is the specific PLA code.
`89258`	Assisted embryo hatching, zona pellucida manipulation	Performed in some IVF workflows near biopsy or transfer; adjunct embryology procedure.
`S4041`	Genetic counseling (when billed as a service by some payors)	Counseling visits for review of PGT results and family planning decisions; relevant to interpretation and patient consent.

OpenPayer

Summary & Overview

CPT 0554U: Smart PGT–SR 24-Chromosome Embryo Analysis