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    v1.0.30
    OpenPayerBilling CodesReproductive Medicine ProceduresCPT cpt-89264-sperm-identification-testicular-tissue
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    CPT 89264: Identification of Sperm from Testicular Tissue

    Commercial payers pay $183 on average nationally for this procedure.

    CPT code 89264 represents laboratory identification of spermatozoa retrieved from fresh or cryopreserved testicular tissue, a specialized andrology laboratory procedure performed to locate viable sperm for use in assisted reproduction; the service is laboratory identification/processing of testicular tissue and the typical site of service is a clinical or hospital-based laboratory supporting reproductive medicine and fertility clinics.

    For related coverage guidance, see recent payer policy updates: Oral Cancer Screening and Testing, RTM Testing for Alpha-1 Antitrypsin Deficiency, Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policy.

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    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.

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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 prior semen analyses demonstrating azoospermia presents for surgical testicular sperm extraction (TESE) with possible cryopreservation. The reproductive endocrinology or urology team coordinates with the laboratory. During the operative procedure, testicular tissue (fresh or previously cryopreserved) is delivered to the clinical laboratory. A laboratory analyst performs microscopic dissection and identification of sperm within the testicular tissue specimen to determine presence of viable sperm for in vitro fertilization or intracytoplasmic sperm injection (ICSI). Documentation includes the source and fresh versus cryopreserved status of the tissue, time of receipt, methods used for tissue processing (mechanical mincing, enzymatic digestion if applicable), number and quality of sperm identified, and disposition (used for ICSI, cryopreserved, or discarded). Typical sites of service include hospital outpatient surgical suite, ambulatory surgery center, or a specialized andrology or reproductive laboratory. Common clinical workflow steps: pre-procedure consent and diagnosis coding (e.g., encounter for fertility testing or male infertility), operative retrieval of testicular tissue, rapid transport to the laboratory, laboratory identification and reporting of sperm presence/quality, and coordination for cryopreservation if required.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    89257Sperm identification from aspiration (other than seminal fluid)

    Related Modifiers

    9 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…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207VE0102X
    207V00000X
    207U00000X
    133VN1101X
    103TA0700X
    225X00000X
    125J00000X
    207YX0602X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    N40.0Benign prostatic hyperplasia without lower urinary tract symptoms
    N40.1Benign prostatic hyperplasia with lower urinary tract symptoms
    N41.0Acute prostatitis
    N41.1Chronic prostatitis
    N41.9Inflammatory disease of prostate, unspecified
    N43.2Other hydrocele
    N43.3Hydrocele, unspecified
    N46.01Organic azoospermia
    N46.11Organic oligospermia
    N46.8Other male infertility

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    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
    Carrier Testing Panels for Genetic Diseases (for Kentucky Only)UnitedHealthcare2026-10-01
    Genetic Testing for Neurological Disorders (for Kansas Only)UnitedHealthcare2026-10-01
    Genetic and Molecular TestingProvidence Health Plan2026-10-01
    Cell-Free Fetal DNA Testing (for Idaho Only)UnitedHealthcare2026-10-01
    Next Generation Sequencing for Minimal Residual Disease DetectionProvidence Health Plan2026-10-01
    Pharmacogenetic Panel Testing (for Kansas Only)UnitedHealthcare2026-10-01
    Non-Covered Genetic Panel TestsProvidence Health Plan2026-10-01

    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-89257-SPERM-IDENTIFICATION-FROM-ASPIRATION

    CPT 89257: Identification of Sperm from Non-Seminal Aspirates

    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

    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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    Similar laboratory identification service for sperm obtained by aspiration; may be performed instead of or alongside tissue identification when aspiration samples are provided
    89335Cryopreservation, reproductive tissue, testicularProcedure used to cryopreserve testicular tissue either immediately after identification of sperm or for future use; often follows positive sperm identification