{"id":181036,"date":"2026-08-18T07:48:23","date_gmt":"2026-08-18T07:48:23","guid":{"rendered":"https:\/\/pabau.com\/?p=181036"},"modified":"2026-08-18T14:06:48","modified_gmt":"2026-08-18T14:06:48","slug":"hcpcs-code-g0027","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/","title":{"rendered":"HCPCS code G0027: Semen analysis billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS code G0027: Semen analysis billing guide\",\"description\":\"HCPCS Code G0027 covers semen analysis for sperm presence and motility, excluding the Huhner test. Medicare asks for CPT 89321 on claims, while G0027 sits on the CLIA provider-performed microscopy list. Includes 2026 CLFS rates, modifiers, ICD-10 pairing, and the CPT 55250 bundle.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0027\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-01\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS code G0027 describes semen analysis for the presence and\/or motility of sperm, and it excludes the Huhner post-coital test.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>For Medicare claims, submit CPT 89321 rather than G0027. There is no CMS or MAC policy that asks for the G-code instead.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>G0027 sits on the CLIA provider-performed microscopy list. That list governs what a PPM-certified office may run in-house, not which code goes on the claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Both codes are priced on the Clinical Laboratory Fee Schedule at a single national rate. On the 2026 file, G0027 pays $6.50 and CPT 89321 pays $12.05.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>When the operating practice runs the post-vasectomy check, CPT 55250 already includes it, so a separate semen analysis line is not billable.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps the ordering provider, diagnosis, and place of service on the patient record. It then submits and tracks the claim from that stored data.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-hcpcs-code-g0027-definition-and-official-descriptor\" class=\"wp-block-heading\">HCPCS code G0027: definition and official descriptor<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">HCPCS code G0027 is an active HCPCS Level II G-code maintained by the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">Centers for Medicare and Medicaid Services (CMS)<\/a>. It covers semen analysis for the presence and\/or motility of sperm. The descriptor carries one explicit exclusion, the Huhner test.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For Medicare claims, submit CPT 89321 rather than G0027. The two codes describe the same laboratory procedure, and G0027 matters to Medicare as a CLIA certification question rather than a claim preference. The table below shows the code attributes.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Attribute<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">G0027<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; presence and\/or motility of sperm excluding huhner<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II G-code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Maintained by<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Centers for Medicare and Medicaid Services (CMS)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Status (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active and valid<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Service category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Clinical laboratory procedure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 CLFS national rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$6.50, with no locality adjustment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code to submit for Medicare<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 89321, priced at $12.05 on the 2026 CLFS<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CLIA status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">On the CMS provider-performed microscopy (PPM) list; needs a PPM certificate or higher<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Excludes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Huhner test (post-coital test)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The Huhner test (also written H\u00fchner) is a distinct post-coital fertility evaluation. It measures how sperm interact with cervical mucus, which a standard semen analysis does not assess. Submitting G0027 for a Huhner test will draw a denial, so keep that line clear in the lab report.<\/p>\n\n\n\n<h2 id=\"h-clinical-use-when-a-g0027-semen-analysis-is-ordered\" class=\"wp-block-heading\">Clinical use: when a G0027 semen analysis is ordered<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A G0027 or 89321 semen analysis is ordered whenever a provider needs to confirm sperm presence or motility on its own. It covers a narrower set of parameters than a full semen analysis panel, which keeps documentation requirements relatively contained.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Common clinical contexts include male infertility workups, post-vasectomy verification, and hormonal therapy follow-ups. Practices serving these populations, including <a href=\"https:\/\/pabau.com\/industry\/mens-health-clinic-software\/\">men&rsquo;s health clinics<\/a> and reproductive medicine groups, meet this test often. Those billing <a href=\"https:\/\/pabau.com\/procedure-codes\/ivf-cpt-codes\/\">IVF procedure codes<\/a> pair it with related laboratory services.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Male infertility workup:<\/strong> ordered when evaluating a male partner for infertility, where sperm presence and motility are the key parameters<\/li>\n\n\n\n<li><strong>Post-vasectomy clearance:<\/strong> confirms azoospermia after vasectomy, usually at 8 to 16 weeks post-procedure. Check the CPT 55250 bundle before billing this separately<\/li>\n\n\n\n<li><strong>Hormonal therapy monitoring:<\/strong> used to assess the effect on sperm while a patient is on testosterone or other hormonal treatment<\/li>\n\n\n\n<li><strong>Baseline fertility screening:<\/strong> general reproductive health assessment before assisted reproduction planning<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Neither code covers a full semen analysis with volume, morphology, and concentration. Those parameters belong to CPT 89320 or 89322. Submitting G0027 when the report reflects a comprehensive analysis undercharges the service and misstates what was performed.<\/p>\n\n\n\n<h2 id=\"h-g0027-vs-cpt-89321-which-code-should-you-submit\" class=\"wp-block-heading\">G0027 vs. CPT 89321: which code should you submit?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Submit CPT 89321 for Medicare. The two codes describe the same laboratory procedure, and AAPC&rsquo;s <a href=\"https:\/\/www.aapc.com\/codes\/coding-newsletters\/my-urology-coding-alert\/reader-questions-payer-preference-determines-g0027-vs-89321-96702-article\" target=\"_blank\" rel=\"nofollow noopener\">Urology Coding Alert<\/a> puts it plainly: for Medicare, use 89321. The choice between them is payer-driven, and Medicare is the payer most often described incorrectly.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices serving fertility patients, including those using <a href=\"https:\/\/pabau.com\/industry\/fertility-clinic-software\/\">fertility clinic software<\/a>, need that default written into the coding workflow. The table below sets the two codes side by side.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Factor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">HCPCS G0027<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 89321<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Maintained by<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS (federal)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">AMA CPT Editorial Panel<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; presence and\/or motility of sperm excluding huhner<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; sperm presence and motility of sperm, if performed<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare claims<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not the code Medicare asks for; no CMS or MAC policy requires it<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use this one, per AAPC coding guidance<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 CLFS national rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$6.50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$12.05<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CLIA position<\/td>\n<td style=\"padding:12px 16px;color:#374151\">On the provider-performed microscopy list; no QW modifier<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Has a QW variant for waived test systems<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Commercial payers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Accepted by some plans; confirm before the first claim<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The usual default, though plan policies still vary<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Risk of guessing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Denial from any payer that wants the CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Denial from a payer that has asked for the G-code in writing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>The practical rule:<\/strong> default to CPT 89321 for Medicare, then verify every other payer. Check the contract or call the benefits line before the first claim goes out. If a payer asks for G0027, get that instruction in writing. Record it in your billing system so coders are not looking it up each time.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Build a payer matrix for your top 10 payers before the next billing cycle. Enter 89321 as the Medicare default, then record what each remaining payer accepts for semen analysis. Ask for written confirmation whenever a payer requests G0027, and re-check the matrix every January.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-medicare-coverage-and-reimbursement-for-semen-analysis\" class=\"wp-block-heading\">Medicare coverage and reimbursement for semen analysis<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays for semen analysis through the Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule. CLFS codes carry no RVUs and no locality adjustment. Since 2018, rates have been set from the weighted median of private payor rates reported under PAMA.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Both codes appear on the 2026 CLFS, at different money. G0027 pays $6.50 and CPT 89321 pays $12.05, so the code you pick roughly halves or doubles the payment. Urology practices billing Medicare for semen analysis should pull the current file each January. It is published on the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/clinical-laboratory-fee-schedule-clfs\" target=\"_blank\" rel=\"nofollow noopener\">CMS Clinical Laboratory Fee Schedule<\/a> page.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Coverage detail<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Status<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare Part B coverage<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, as a clinical diagnostic laboratory service<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code to submit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 89321 for Medicare claims; G0027 only where a payer asks for it in writing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Fee schedule used<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Clinical Laboratory Fee Schedule (CLFS), not the Physician Fee Schedule<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Reimbursement rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A single national rate with no locality adjustment. The 2026 file lists $6.50 for G0027 and $12.05 for 89321<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">How the rate is set<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Weighted median of private payor rates reported under PAMA, in force since 2018<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CLIA requirement<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The performing lab needs the right CLIA certificate, and its CLIA number belongs on the claim<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Prior authorization<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not typically required for Medicare; verify with your MAC<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Patient cost-sharing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">None. The Part B deductible and coinsurance do not apply to tests paid under the CLFS<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare Advantage (Part C) plans set their own coverage and coding rules. A patient in an Advantage plan may not be covered on traditional Part B terms. The plan may also state a code preference of its own. Verify the plan type before submitting.<\/p>\n\n\n\n<h2 id=\"h-clia-scope-what-the-g0027-ppm-listing-governs\" class=\"wp-block-heading\">CLIA scope: what the G0027 PPM listing governs<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">G0027&rsquo;s Medicare-specific significance is a certificate question, not a claim question. The code appears on the CMS provider-performed microscopy procedures list, which sets what a PPM-certified office may run in-house during the patient visit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A CLIA Certificate for PPM lets a licensed physician, midlevel practitioner, or dentist perform a defined set of moderately complex microscopy procedures. G0027 shares that list with wet mounts (Q0111), KOH preparations (Q0112), the fern test (Q0114), and urinalysis with microscopy (81000, 81001, 81015).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two practical consequences follow. A PPM certificate also covers waived tests, so a PPM-certified office can run both categories. And because a PPM procedure is not a waived test, modifier QW is not appended to G0027.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nothing on the PPM list dictates which code goes on a claim. That is why the two questions get conflated so often. The list tells you whether your office may perform the test on site, while the payer tells you which code to submit for it.<\/p>\n\n\n\n<h2 id=\"h-post-vasectomy-semen-analysis-and-the-cpt-55250-bundle\" class=\"wp-block-heading\">Post-vasectomy semen analysis and the CPT 55250 bundle<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">When the operating practice runs the post-vasectomy check, the analysis has already been paid. The AMA descriptor for <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-55250\/\">CPT 55250<\/a> reads: vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That wording holds regardless of payer. Billing 89321 or G0027 alongside 55250 from the same provider or practice triggers a National Correct Coding Initiative bundling edit. The routine sperm count that confirms sterility is part of the vasectomy&rsquo;s global package.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One exception matters in practice. Say the vasectomy was performed elsewhere and the patient comes to you only for the semen analysis. In that case your practice may bill the analysis on its own. Document where the vasectomy took place so the claim can survive an edit or an appeal.<\/p>\n\n\n\n<h2 id=\"h-applicable-modifiers-for-hcpcs-code-g0027\" class=\"wp-block-heading\">Applicable modifiers for HCPCS code G0027<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifiers are rarely needed on a semen analysis claim, and one of the modifiers commonly attached to G0027 does not belong there at all. Applying the wrong modifier, or omitting a required one, invites review or denial.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">QW<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not applicable to G0027<\/td>\n<td style=\"padding:12px 16px;color:#374151\">QW flags a CLIA-waived test. G0027 is a PPM-list procedure, so a PPM certificate covers it and no modifier is added. The CLFS does list a QW variant for 89321<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A signed ABN is on file for a service you expect Medicare to deny<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The denial then transfers liability to the patient, so you can bill them directly<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GY<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The service is statutorily excluded or not a Medicare benefit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Produces the denial you need before collecting from the patient or a secondary payer<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GZ<\/td>\n<td style=\"padding:12px 16px;color:#374151\">You expect a not-medically-necessary denial and no ABN was obtained<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Liability stays with the practice. Without an ABN, the charge cannot be passed to the patient<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier rules vary by payer. What Medicare treats as standard may be read differently by a commercial carrier. Verify applicability with each payer before appending anything to a semen analysis claim.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-paired-with-g0027\" class=\"wp-block-heading\">ICD-10 diagnosis codes paired with G0027<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every semen analysis claim needs a supporting ICD-10-CM diagnosis that justifies medical necessity. The N46 series covers male infertility and is the most common diagnostic group used here.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N46.01<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Organic azoospermia<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infertility workup<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N46.11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Organic oligospermia<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infertility workup<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N46.8<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other male infertility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when no more specific subcode applies<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N46.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Male infertility, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use only when the subtype is not documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z30.2<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for sterilization<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The vasectomy encounter itself<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z98.52<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Vasectomy status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Post-vasectomy checks; confirm the 55250 bundle first<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z31.41<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for fertility testing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Baseline screening before assisted reproduction<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Use the most specific code the documentation supports. Defaulting to N46.9 when the record clearly identifies oligospermia is under-coding, and it invites scrutiny on audit. The ordering provider must have documented the diagnosis before the claim goes out.<\/p>\n\n\n\n<h2 id=\"h-g0027-billing-guidelines-and-documentation-requirements\" class=\"wp-block-heading\">G0027 billing guidelines and documentation requirements<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Clean semen analysis claims share a consistent documentation pattern. Missing any element below is enough to trigger an automated denial or a request for more information. Practices using <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> can build pre-submission checklists that catch these before the claim leaves the practice.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0027\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau submits lab claims electronically from the ordering provider, diagnosis, and place-of-service details already stored on the patient record.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Code selection recorded per payer:<\/strong> note 89321 as the Medicare default, and keep written evidence for any payer that asks for G0027 instead.<\/li>\n\n\n\n<li><strong>Ordering provider identity:<\/strong> the name and NPI of the ordering provider must appear on the claim. This is a laboratory procedure ordered by a qualified provider, not self-ordered by the lab.<\/li>\n\n\n\n<li><strong>Diagnosis matching the documentation:<\/strong> the ICD-10-CM code submitted must be supported by the ordering provider&rsquo;s documented indication. A diagnosis of N46.01 requires that the provider recorded it in the notes or referral.<\/li>\n\n\n\n<li><strong>CLIA number on the claim:<\/strong> the performing lab&rsquo;s certificate number belongs in item 23 of the CMS-1500. The certificate type must also cover the test performed.<\/li>\n\n\n\n<li><strong>Place of service:<\/strong> code 81 (independent laboratory) is standard for lab-only billing. A physician office lab uses POS 11. An incorrect POS is a common and avoidable denial trigger.<\/li>\n\n\n\n<li><strong>Specimen handling notation:<\/strong> record the specimen type and collection context. Some MACs have asked for specimen handling details during post-payment audits of semen analysis claims.<\/li>\n\n\n\n<li><strong>Huhner exclusion verification:<\/strong> confirm in the lab report that no Huhner post-coital test was performed. If it was, the service belongs under CPT 89300 instead.<\/li>\n\n\n\n<li><strong>Standard claim format:<\/strong> claims go out as an <a href=\"https:\/\/pabau.com\/blog\/837-file\/\">837P transaction<\/a> or on the CMS-1500. Confirm your <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA compliance documentation<\/a> covers claim submission before filing.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Labs and urology practices using <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">medical forms for healthcare practices<\/a> in intake capture the ordering provider and clinical indication at the point of service. Chasing those details after the lab work is finished only adds delay to the <a href=\"https:\/\/pabau.com\/blog\/what-is-revenue-cycle-management\/\">revenue cycle<\/a>.<\/p>\n\n\n\n<h2 id=\"h-common-denial-reasons-for-g0027-and-how-to-avoid-them\" class=\"wp-block-heading\">Common denial reasons for G0027 and how to avoid them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most semen analysis denials fall into a small number of repeatable patterns, each with its own <a href=\"https:\/\/pabau.com\/blog\/denial-codes-in-medical-billing\/\">denial code<\/a>. Working out which ones hit your practice hardest is the fastest route to a better first-pass acceptance rate.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>G0027 sent to Medicare:<\/strong> Medicare asks for CPT 89321, not the G-code. Resolution: set 89321 as your Medicare default.<\/li>\n\n\n\n<li><strong>Wrong code for a commercial payer:<\/strong> a plan that requires one code will reject the other. Resolution: keep a payer-preference lookup in the billing workflow and review it annually.<\/li>\n\n\n\n<li><strong>Bundled into CPT 55250:<\/strong> a post-vasectomy analysis billed separately by the operating practice hits an NCCI edit. Resolution: flag vasectomy patients at intake so the check is not billed twice.<\/li>\n\n\n\n<li><strong>Missing or unsupported diagnosis:<\/strong> no ICD-10-CM code, or one that does not match what was documented. Resolution: require a completed referral order before processing the lab request.<\/li>\n\n\n\n<li><strong>CLIA certificate mismatch:<\/strong> the claim&rsquo;s CLIA number does not cover the complexity of the test performed. Resolution: check that your certificate type covers PPM procedures before running the test in-house.<\/li>\n\n\n\n<li><strong>Incorrect place of service:<\/strong> POS 81 submitted for a physician office lab, or POS 11 for an independent lab. Resolution: map each billing location to its POS code and automate the selection.<\/li>\n\n\n\n<li><strong>Missing ordering provider NPI:<\/strong> the claim lacks the ordering or referring provider NPI in box 17. Resolution: make NPI capture a required field at lab order intake.<\/li>\n\n\n\n<li><strong>Huhner test confusion:<\/strong> a post-coital test billed as G0027. Resolution: verify the service performed against the descriptor before the claim is built.<\/li>\n<\/ul>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a denial analysis on your last 90 days of semen analysis claims. Pull the denial reason codes, with CO-4, CO-97 and CO-16 the usual suspects, and tally how many land in each category. In most practices two or three denial types account for over 80% of rejections. Fix those before optimizing for edge cases.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-code-history-and-annual-updates-for-hcpcs-code-g0027\" class=\"wp-block-heading\">Code history and annual updates for HCPCS code G0027<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">G0027 has held a stable descriptor since it entered the HCPCS Level II code set. CMS publishes HCPCS updates each January, and the code has stayed active without descriptor changes or retirement. Its 2026 status is confirmed in the CMS CLFS file.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Year<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Status<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor change<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No change<\/td>\n<td style=\"padding:12px 16px;color:#374151\">On the Q1 CLFS at $6.50; valid for current billing year<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2025<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No change<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stable code year<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2024<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No change<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stable code year<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Check the code&rsquo;s status and rate in the first week of each January. CMS releases the updated HCPCS file and the revised CLFS together, and the CLFS is reissued quarterly. Waiting for claims to bounce is a costly way to learn about a rate change.<\/p>\n\n\n\n<h2 id=\"h-related-codes-to-use-alongside-or-instead-of-g0027\" class=\"wp-block-heading\">Related codes to use alongside or instead of G0027<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">G0027 covers a narrow slice of semen analysis. When the clinical scope is broader, or a different test is performed, the codes below apply. Rates come from the 2026 CLFS Q1 file. Practices coding other clinical laboratory services, such as <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0141\/\">G0141<\/a>, should confirm the CLIA and payer rules for each code separately.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Official descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 CLFS rate<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Relationship to G0027<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT 89321<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; sperm presence and motility of sperm, if performed<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$12.05<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The equivalent code, and the one to submit for Medicare<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT 89300<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; presence and\/or motility of sperm including huhner test (post coital)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$9.84<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Covers the Huhner test that G0027 explicitly excludes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT 89310<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; motility and count (not including huhner test)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$8.61<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Adds a sperm count; some payers use it in place of 89321<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT 89320<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; volume, count, motility, and differential<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$12.31<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Full semen analysis, with a broader scope than G0027<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT 89322<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Semen analysis; volume, count, motility, and differential using strict morphologic criteria<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$15.50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The strict morphology version of 89320<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT 89329<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sperm evaluation; hamster penetration test<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$19.59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A distinct fertility test, not interchangeable with G0027<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT 55250<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not on the CLFS; paid under the Physician Fee Schedule<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bundles the post-vasectomy check when one practice does both<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The NLM Clinical Table Search API carries the full HCPCS Level II and CPT code sets for programmatic lookups. AAPC offers a searchable interface. Never infer a related code from the procedure name. Confirm the clinical scope first, then confirm the payer accepts that code for this patient&rsquo;s coverage.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-supports-semen-analysis-billing\" class=\"wp-block-heading\">How Pabau supports semen analysis billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most semen analysis denials start at a handoff. The ordering provider documents the indication, and the front desk handles the specimen. Days later the billing team builds the claim from whatever reached the record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps those pieces in one place. The ordering provider, their NPI, the documented diagnosis, and the place of service all live on the patient record. Pabau then submits and tracks the claim from that stored data. Your coder still chooses the code and any modifier, so the payer-preference rule stays a human decision made against a complete record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For practices managing intake and consent digitally, <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital intake forms<\/a> capture the referring provider and the clinical indication before the specimen is processed. Recent vasectomy history can be captured the same way, which is what stops a bundled post-vasectomy check from being billed twice.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-g0027\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s intake forms capture the referring provider and clinical indication before the specimen reaches the lab bench.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Practices using <a href=\"https:\/\/pabau.com\/features\/medical-lab-software\/\">lab management software<\/a> alongside billing tools can link the lab order to the claim, giving you a traceable line from specimen to payment. That matters here because semen analysis codes attract post-payment review, and an auditable chain is the difference between a clean response and an overpayment demand.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Get semen analysis claims right the first time                <\/h3>\n\n                <p class=\"description\">\n                    Pabau keeps ordering provider details, diagnoses and place of service on the patient record. Urology and reproductive health teams then submit and track the claim from it. See how it works in a live demo.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Semen analysis billing turns on one correction. Medicare wants CPT 89321, and G0027&rsquo;s Medicare-specific role is CLIA scope, meaning what a PPM-certified office may run in-house. Treat any request for the G-code as payer-specific, and get it in writing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two checks close the remaining exposure. Confirm the payer&rsquo;s code preference before the first claim goes out. Then check whether CPT 55250 already covers the post-vasectomy analysis you are about to bill.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&rsquo;s <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">practice management software<\/a> ties ordering provider documentation, diagnosis records, and claim submission into one traceable workflow. If your semen analysis denial rate has been creeping up, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> to see where the friction leaves your laboratory claims.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want fewer rejected lab claims?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/clean-claim\/\">Clean claim<\/a> sets out the data a payer needs to pay on the first pass.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Building a documentation checklist for lab billing?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/medical-billing-compliance\/\">Medical billing compliance<\/a> covers the laws and the violations that draw penalties.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Checking coverage before the specimen arrives?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/insurance-eligibility-verification\/\">Insurance eligibility verification<\/a> shows how to confirm benefits ahead of every visit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Reconciling what the payer actually paid?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/electronic-remittance-advice\/\">Electronic remittance advice<\/a> explains how remittance files report each adjustment.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Not sure how long you have to file?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/timely-filing-limits\/\">Timely filing limits<\/a> lists the deadlines by payer for claims and appeals.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786952378285\"><h3 class=\"schema-faq-question\">What does HCPCS code G0027 cover?<\/h3> <p class=\"schema-faq-answer\">HCPCS code G0027 covers semen analysis for the presence and\/or motility of sperm, excluding the Huhner post-coital test. It is a CMS-maintained HCPCS Level II G-code, and it sits on the CLIA provider-performed microscopy list.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952378286\"><h3 class=\"schema-faq-question\">What is the difference between G0027 and CPT 89321?<\/h3> <p class=\"schema-faq-answer\">The two codes describe the same laboratory procedure and are treated as equivalent. G0027 is maintained by CMS and 89321 by the AMA. Which one you submit is payer-driven, and for Medicare the answer is CPT 89321.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952378287\"><h3 class=\"schema-faq-question\">Is G0027 covered by Medicare?<\/h3> <p class=\"schema-faq-answer\">Yes. G0027 is priced on the Clinical Laboratory Fee Schedule at $6.50 nationally for 2026. Medicare still asks for CPT 89321, which pays $12.05 on the same schedule. CLFS rates are national and are not locality-adjusted.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952378288\"><h3 class=\"schema-faq-question\">What modifiers apply to HCPCS G0027?<\/h3> <p class=\"schema-faq-answer\">GA, GY and GZ can apply, depending on the ABN and the coverage situation. Modifier QW does not apply, because QW flags a CLIA-waived test and G0027 is a provider-performed microscopy procedure. Confirm modifier rules with each payer.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952378291\"><h3 class=\"schema-faq-question\">When should I use G0027 instead of CPT 89321?<\/h3> <p class=\"schema-faq-answer\">Only when a specific non-Medicare payer has confirmed in writing that it requires the G-code for semen analysis. G0027 is not the Medicare default, and no CMS or MAC policy requires it on a Part B claim.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786952378292\"><h3 class=\"schema-faq-question\">Can I bill a semen analysis after a vasectomy?<\/h3> <p class=\"schema-faq-answer\">Not if your practice performed the vasectomy. CPT 55250 includes postoperative semen examinations, so a separate line triggers an NCCI bundling edit. A different practice that only runs the analysis may bill it on its own.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>HCPCS code G0027: definition and official descriptor HCPCS code G0027 is an active HCPCS Level II G-code maintained by the Centers for Medicare and Medicaid Services (CMS). It covers semen analysis for the presence and\/or motility of sperm. The descriptor carries one explicit exclusion, the Huhner test. For Medicare claims, submit CPT 89321 rather than [&hellip;]<\/p>\n","protected":false},"author":84,"featured_media":181034,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"83","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[1364,1582,2796,2559],"class_list":["post-181036","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-billing","tag-hcpcs","tag-laboratory","tag-urology-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS code G0027: Semen analysis billing guide<\/title>\n<meta name=\"description\" content=\"Medicare wants CPT 89321 for semen analysis, not HCPCS G0027. 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Which one you submit is payer-driven, and for Medicare the answer is CPT 89321.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378287","position":3,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378287","name":"Is G0027 covered by Medicare?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. G0027 is priced on the Clinical Laboratory Fee Schedule at $6.50 nationally for 2026. Medicare still asks for CPT 89321, which pays $12.05 on the same schedule. CLFS rates are national and are not locality-adjusted.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378288","position":4,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378288","name":"What modifiers apply to HCPCS G0027?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"GA, GY and GZ can apply, depending on the ABN and the coverage situation. Modifier QW does not apply, because QW flags a CLIA-waived test and G0027 is a provider-performed microscopy procedure. Confirm modifier rules with each payer.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378291","position":5,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378291","name":"When should I use G0027 instead of CPT 89321?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Only when a specific non-Medicare payer has confirmed in writing that it requires the G-code for semen analysis. G0027 is not the Medicare default, and no CMS or MAC policy requires it on a Part B claim.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378292","position":6,"url":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-g0027\/#faq-question-1786952378292","name":"Can I bill a semen analysis after a vasectomy?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Not if your practice performed the vasectomy. CPT 55250 includes postoperative semen examinations, so a separate line triggers an NCCI bundling edit. A different practice that only runs the analysis may bill it on its own.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"}]}},"yoast":{"focus_keyword":"HCPCS Code G0027","seo_title":"HCPCS code G0027: Semen analysis billing guide","meta_description":"Medicare wants CPT 89321 for semen analysis, not HCPCS G0027. See 2026 CLFS rates, CLIA PPM scope, modifiers and the 55250 bundle.","content_score":"90","is_cornerstone":"","related_keyphrases":[{"keyword":"g0027 vs 89321","score":61},{"keyword":"g0027 medicare reimbursement","score":61},{"keyword":"g0027 billing guidelines","score":61},{"keyword":"male infertility billing codes","score":61},{"keyword":"medicare laboratory billing","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/181036","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/users\/84"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/comments?post=181036"}],"version-history":[{"count":5,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/181036\/revisions"}],"predecessor-version":[{"id":184430,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/posts\/181036\/revisions\/184430"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/media\/181034"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/media?parent=181036"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/categories?post=181036"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/fr\/wp-json\/wp\/v2\/tags?post=181036"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}