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CPT 89264: Identification of Sperm from Testicular Tissue
CPT code 89264 represents the laboratory identification of spermatozoa from testicular tissue specimens, including both fresh and cryopreserved samples. This microscopic identification is a critical step in assisted reproductive technology workflows for patients with severe male factor infertility, such as azoospermia or other testicular sperm production disorders. Nationally, accurate coding for this specialized laboratory procedure affects claims processing, coverage determinations, and access to fertility services.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common diagnostic indications, and how 89264 relates to adjacent services in reproductive laboratory care. The publication provides benchmarks and coding relationships to related procedures used in sperm retrieval and cryopreservation workflows, and it highlights policy and billing considerations that commonly arise when reporting laboratory identification of testicular sperm.
This summary equips billing professionals, laboratory directors, and reproductive specialists with a clear description of the service represented by CPT code 89264, points of alignment with related reproductive laboratory procedures, and the payer landscape relevant to national coverage and claims handling.
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Billing Code Overview
CPT code 89264 describes the laboratory identification of sperm retrieved from testicular tissue, whether the tissue is fresh or cryopreserved. This service involves a laboratory analyst performing microscopic and ancillary techniques to locate and identify spermatozoa in testicular specimens.
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Service type: Laboratory sperm identification from testicular tissue
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Typical site of service: Clinical laboratory or assisted reproductive technology (ART) laboratory associated with a fertility clinic or hospital
National Reimbursement Benchmarks
Commercial reimbursement for CPT 89264 centers around the BUCA average commercial rate of $183.50, with individual payers showing notable variability. Blue Cross Blue Shield (BCBS) and Aetna both have higher upper tails (BCBS max $500, Aetna max $381.70) while Cigna and UnitedHealth Group present elevated upper extremes (Cigna max $850.50, UnitedHealth Group max $651.00). Cigna’s distribution is relatively compressed between the 25th and 75th percentiles ($116.00–$144.30), while Aetna and BCBS span wider interquartile ranges that reflect broader commercial negotiation outcomes.
Assessing dispersion (P75 minus P25) quantifies that UnitedHealth Group is the widest at $288.20 (P75 $353.50 minus P25 $63.00), followed by BCBS at $118.80 and BUCA at $130.60. Cigna is the tightest with a spread of $28.30, indicating more clustered commercial pricing. Aetna’s IQR is $222.00, showing substantial middle-range variability compared with the BUCA average commercial benchmark.