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    v1.0.30
    OpenPayerBilling CodesReproductive Medicine ProceduresCPT cpt-89257-sperm-identification-from-aspiration
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    CPT 89257: Identification of Sperm from Non-Seminal Aspirates

    Commercial payers pay $153 on average nationally for this procedure.

    CPT code 89257 describes laboratory identification of sperm cells obtained by aspiration from sources other than seminal fluid or semen, a diagnostic laboratory service used in reproductive and male infertility evaluations; service type: laboratory identification/diagnostic sperm identification; typical site of service: clinical laboratory or hospital laboratory performing and reporting sperm identification from aspirated specimens.

    For related coverage guidance, see recent payer policy updates: Prenatal (Fetal) Diagnostic Testing, Oral Cancer Screening and Testing, RTM Testing for Alpha-1 Antitrypsin Deficiency.

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    National Reimbursement Benchmarks

    For CPT 89257, the BUCA average commercial rate sits at $152.80, offering a mid-market reference point against individual payer distributions. Blue Cross Blue Shield and Aetna present wide dispersion, with interquartile ranges of $149.50 (BCBS P75 $240.70 minus P25 $109.20) and $164.80 (Aetna P75 $315.00 minus P25 $150.20) respectively, indicating substantial variability in contracted rates. UnitedHealth Group and Cigna show much tighter spreads: UnitedHealth Group’s IQR is $6.40 (P75 $63.30 minus P25 $59.90) and Cigna’s IQR is $1.10 (P75 $3.70 minus P25 $2.60), reflecting more consistent pricing among their networks.

    Looking at central tendency, Aetna’s mean of $221.80 sits above the BUCA average, while Blue Cross Blue Shield’s mean of $191.20 is also above BUCA. UnitedHealth Group’s mean of $60.70 and Cigna’s mean of $22.70 fall below the BUCA average, illustrating a bimodal market: a cluster of higher means (Aetna, Blue Cross Blue Shield) and a cluster of lower means (UnitedHealth Group, Cigna). BUCA’s average is useful as a commercial midpoint but does not capture the wide payer-by-payer variability highlighted by the interquartile comparisons.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 34-year-old man with a 12-month history of infertility and an abnormal semen analysis (severe oligospermia and intermittent cryptozoospermia) is referred by a reproductive endocrinologist for targeted laboratory evaluation. The clinical workflow begins with specimen collection by a urology or assisted reproduction clinic: the patient undergoes testicular aspiration or epididymal aspiration (e.g., percutaneous or open micro-TESE/aspiration) when ejaculated semen contains no or insufficient sperm. The aspirate is transported to the clinical laboratory under controlled temperature with appropriate chain-of-custody documentation when for assisted reproductive technology (ART).

    In the laboratory, a trained technologist performs a macroscopic inspection and prepares slides. The lab analyst executes microscopic identification procedures to detect, isolate, and document the presence of spermatozoa from non-semen sources (testicular or epididymal tissue/aspirate). Findings (presence/absence, approximate count, motility if any) are reported to the ordering physician and reproductive team. Results guide next steps: direct intra-cytoplasmic sperm injection (ICSI) planning, cryopreservation of retrieved sperm, or further surgical/interventional management. Typical sites of service include hospital-based outpatient laboratories, specialized andrology/reproductive endocrinology laboratories, and accredited fertility clinics associated with obstetrics & gynecology or urology practices.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    89260

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207V00000X
    207U00000X
    207ZP0102X
    363AM0700X
    207XS0117X
    261QH0100X
    332BN1400X
    1835S0206X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    N43.3Hydrocele, unspecified
    N45.1Epididymitis
    N45.2Orchitis
    N45.3Epididymo-orchitis
    N46.01Organic azoospermia
    N46.02
    N46.11Organic oligospermia
    N46.8Other male infertility
    N46.9Male infertility, unspecified
    N47.1Phimosis

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Prenatal (Fetal) Diagnostic TestingBlue Cross Blue Shield - Rhode Island2027-01-01
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Polygenic Risk ScoreBlue Cross Blue Shield - Rhode Island2026-12-01
    Gene Expression Profiling for Cutaneous MelanomaBlue Cross Blue Shield - Rhode Island2026-12-01
    Genetic Testing for Diagnosis and Management of Mental Health ConditionsBlue Cross Blue Shield - Rhode Island2026-11-01
    Molecular Testing in the Management of Pulmonary NodulesBlue Cross Blue Shield - Rhode Island2026-11-01
    Genetic Testing for Hereditary Cancer (for North Carolina Only)Colorado Rocky Mountain Health Plans2026-10-01
    Expanded Molecular Testing of Cancers to Select Targeted TherapiesBlue Cross Blue Shield - North Dakota2026-10-01

    Related Codes

    CPT-89250-SHORT-TERM-OOCYTE-EMBRYO-CULTURE-ART

    CPT 89250: Oocyte or Embryo Culture <4 Days

    CPT-89251-OOCYTE-EMBRYO-SHORT-TERM-COCULTURE-ART

    CPT 89251: Oocyte/Embryo Culture with Coculture (<4 days)

    CPT-89253-ASSISTED-EMBRYO-HATCHING-PARTIAL-ZONA-DISSECTION

    CPT 89253: Assisted Embryo Hatching, Partial Zona Dissection

    CPT-89254-FOLLICULAR-FLUID-OOCYTE-IDENTIFICATION-LAB

    CPT 89254: Oocyte Identification from Follicular Fluid

    CPT-89255-EMBRYO-PREPARATION-FOR-TRANSFER-ART

    CPT 89255: Embryo Preparation for Transfer (ART)

    CPT-89258-EMBRYO-CRYOPRESERVATION-IVF

    CPT 89258: Embryo Cryopreservation During IVF Cycle

    CPT-89259-SPERM-CRYOPRESERVATION-AND-PRESERVATION

    CPT 89259: Sperm Cryopreservation, Laboratory Processing

    CPT-89260-LABORATORY-SPERM-PREPARATION-SPERM-WASH-SWIM-UP

    CPT 89260: Sperm Isolation for Sperm Wash and Swim‑Up Preparation

    CPT-89261-SPERM-PREPARATION-AND-SEMEN-ANALYSIS

    CPT 89261: Complex Sperm Preparation and Semen Analysis

    CPT-89264-SPERM-IDENTIFICATION-TESTICULAR-TISSUE

    CPT 89264: Identification of Sperm from Testicular Tissue

    Showing 1–10 of 36

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Sperm isolation; simple prep
    May be performed after identification to concentrate sperm from fluid aspirates for cryopreservation or ART.
    89261Sperm isolation; complex prepUsed when additional or more complex isolation techniques are required (e.g., multiple gradient steps) following identification from tissue aspirates.
    89300Semen analysis; presence and/or motility of spermPerformed on ejaculated semen; complementary diagnostic test when ejaculate is available prior to or after aspirate-based identification.
    89320Semen analysis; volume, count, motility, and differentialComprehensive semen analysis used in initial infertility workup; provides baseline data that may prompt aspiration and 89257.
    89321Semen analysis; sperm presence and motility of sperm, if performedAdditional or reflex testing for presence/motility often ordered in conjunction with other semen analyses and laboratory processing surrounding aspirate identification.