Summary & Overview
HCPCS S4026: Procurement of Donor Sperm from Sperm Bank
HCPCS Level II code S4026 denotes the procurement of donor sperm from a sperm bank for use in assisted reproductive services. This code identifies acquisition of donor gametes as a distinct billable supply or service, relevant to fertility clinics and reproductive medicine providers. Nationally, use of S4026 matters for claims processing, coverage determination, and benefit design for infertility services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for donor sperm procurement, typical sites of service, and the role this code plays in billing workflows. The publication also summarizes common modifiers associated with billing for ancillary supplies and services, notes gaps where input data is not available, and outlines topics relevant to policy and reimbursement such as coverage variability, documentation needs, and coding best practices. The content is geared to billing specialists, revenue cycle managers, and clinicians seeking a practical reference for S4026 and its application in reproductive health claims.
Billing Code Overview
HCPCS Level II code S4026 represents procurement of donor sperm from a sperm bank. This service is categorized as donor gamete procurement, with the primary service type being sperm procurement/acquisition.
The typical site of service for S4026 is an outpatient clinic, reproductive medicine center, or fertility clinic where donor sperm is requested, processed, and supplied for assisted reproductive procedures such as intrauterine insemination or in vitro fertilization. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 34-year-old cisgender woman presents to a reproductive endocrinology clinic seeking donor sperm for intrauterine insemination (IUI) as part of an assisted reproduction cycle. The patient has a history of partner azoospermia and prior unsuccessful attempts at conception. The clinic staff coordinates procurement of donor sperm from an accredited sperm bank; the service billed is for the acquisition and transfer of the donor specimen to the treating facility. Typical workflow: the clinician documents indication and informed consent, orders donor selection and screening through the sperm bank, confirms donor unit availability and quarantine testing status, arranges payment and shipping, and receives the specimen at the clinic on the scheduled treatment day. The specimen is logged, thawed or prepared per protocol, and used for IUI or IVF insemination procedures. Typical site of service is an outpatient fertility clinic or ambulatory reproductive health center. Typical patient scenario includes single women, same-sex female couples, or heterosexual couples with male-factor infertility receiving donor sperm procurement for use in IUI, timed intercourse, or IVF cycles. Relevant care team includes reproductive endocrinologists (MD/DO), clinical embryologists or andrology technologists, nursing staff, and administrative personnel managing ordering and billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Typically not in common CMS modifier list; retained as provided | Use only if specified by payer instructions for identity or internal use; confirm payer guidance |