CPT code 89290 – Embryo biopsy for preimplantation genetic testing

Key takeaways

CPT Code 89290 reports a biopsy session of five or fewer embryos for preimplantation genetic testing. A session of more than five embryos bills 89291 instead, and the two codes are never billed together.

The code does not include PGT genetic analysis, embryo culture, oocyte retrieval, or fertilization. Each of those is billed separately.

Most commercial payers require prior authorization and a supported ICD-10 diagnosis (e.g. Z31.83) before paying 89290. Traditional Medicare generally does not cover IVF-related procedures.

Pabau, the practice management platform we build, links the embryology record to charge capture, so coders bill from the lab’s own embryo count.

CPT Code 89290: Official descriptor and code details

CPT Code 89290 describes “Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); less than or equal to 5 embryos.” The American Medical Association (AMA) publishes and maintains the CPT code set.

It places 89290 in the reproductive medicine procedures subsection (89250-89398) of the Pathology and Laboratory section. It is a Category I code, meaning it describes a service with established clinical utility.

89290 has one sibling, 89291, and the two are alternatives. The total number of embryos biopsied in the session decides which one goes on the claim. The table below captures the facts a coder needs before building that claim.

What the embryo biopsy procedure involves

A clinical embryologist performs embryo biopsy in the ART laboratory. It typically happens on day 5 or 6 of culture, once the embryo has reached the blastocyst stage. The embryologist removes 3 to 10 trophectoderm cells from the outer cell layer using a laser or mechanical technique.

The biopsy sample then goes to a genetics laboratory for PGT analysis. The biopsied embryo is vitrified (flash-frozen) while awaiting results. Thawing it later for a frozen transfer is a separate service, billed under 89352.

Earlier cleavage-stage biopsy (day 3, removing a single blastomere) is now less common because trophectoderm biopsy yields more DNA and causes less developmental disruption. Cleavage-stage and blastocyst-stage biopsies use the same pair of codes.

The total number of embryos biopsied in the session picks the code: 89290 for five or fewer, 89291 for more than five. The number of cells removed per embryo changes neither the code nor the single unit.

What CPT 89290 covers and what it excludes

Knowing what falls inside and outside 89290 prevents the two most common charge-capture errors at fertility centers. One is unbundling services that are part of the biopsy. The other is failing to bill services that are genuinely distinct.

89290 vs 89291: Choosing the code by embryo count

CPT 89290 and 89291 are alternative codes for the same biopsy service, and each claim carries only one of them per session. The total number of embryos biopsied in that session decides which.

A session of five or fewer embryos bills 89290, and a session of more than five bills 89291. Either code is reported as one unit, as the decision below shows.

89291 is not an add-on code. It carries no “+” add-on marker in the CPT code set, and its descriptor has no “each additional embryo” wording. Billing 89290 and 89291 together for one session reports the same biopsy twice, which payers deny as a duplicate service.

Billing example: A session in which seven blastocysts are biopsied for PGT-A bills 89291 × 1 unit, and nothing else for the biopsy. It does not bill 89290 for embryos one to five plus 89291 for the other two. Count the embryos once the session is complete, then pick the code.

Our guide to IVF procedure codes covers the complete 89000-series. It also lists the clinical procedure codes that sit around the ART laboratory work.

Commonly confused codes: 89290 and its neighbors

Four codes appear alongside 89290 in ART coding discussions. Confusing them costs claims.

Can CPT 89290 be billed with assisted hatching (89253)?

Yes, in specific circumstances, but only with careful documentation. Assisted hatching (CPT 89253) creates an opening in the zona pellucida with a laser or chemical technique. Its usual purpose is to help an embryo implant.

When a practice performs both assisted hatching and embryo biopsy for PGT on the same embryo in the same cycle, both codes may be reported. The American Society for Reproductive Medicine (ASRM) acknowledges that these are distinct procedures with different clinical purposes.

However, payers apply bundling edits under the National Correct Coding Initiative (NCCI). Some payers treat 89253 as part of the biopsy when it is performed immediately before trophectoderm biopsy. Their reasoning is that the zona pellucida must be opened to reach the trophectoderm cells. To override a bundling edit, the operative note must clearly document:

• That assisted hatching was performed for a separate, distinct clinical indication (not solely to facilitate biopsy access)
• The technique used for each procedure (laser parameters or chemical concentration)
• The embryo identifier for each procedure (chain-of-custody notation)
• Modifier 59 (Distinct Procedural Service) appended to 89253 on the claim line

Without all four elements, expect a bundling denial. Verify current NCCI edits against the AAPC CPT code reference before assuming the edit does not apply to a specific payer contract.

ICD-10 diagnosis codes that support CPT Code 89290

Every 89290 claim needs a supporting ICD-10-CM diagnosis code that establishes the medical necessity of PGT. Payers cross-reference the diagnosis against the covered indication list in their benefit policy before adjudicating the claim. Using a vague or non-specific code is one of the fastest routes to denial.

Payer acceptance of these codes varies. Always verify the current covered-diagnosis list against the specific plan’s ART or fertility benefit policy before submitting. Z31.83 is the most consistently accepted code across commercial plans that offer IVF benefits, but it does not guarantee coverage on its own.

Payer coverage and prior authorization for embryo biopsy billing

Traditional Medicare (Parts A and B) does not cover IVF or ART laboratory services, including CPT Code 89290. Medicare’s exclusion of IVF-related procedures is longstanding CMS policy.

Medicare Advantage (Part C) plans set their own benefit structures, and a small number offer limited fertility benefits. Check the individual plan’s evidence of coverage before concluding Medicare will not pay. Verify current Local Coverage Determinations (LCDs) through the CMS Medicare Coverage Database.

For commercial payers, coverage depends on whether the employer or health plan has purchased an infertility benefit rider. As of 2024, 21 US states had mandated some form of infertility coverage for large group plans.

The procedures covered and the cycle limits vary significantly by state and plan design. Prior authorization is required by most payers that do cover 89290. The authorization request typically needs to include:

• A genetics referral or letter of medical necessity from the reproductive endocrinologist
• The PGT indication (PGT-A, PGT-M, or PGT-SR) and the clinical reason
• Estimated number of embryos expected to be available for biopsy
• Documentation that less invasive alternatives were considered or are not appropriate

Never assume a prior authorization for the IVF cycle covers 89290. Many payers issue separate authorizations for the clinical procedures (stimulation, retrieval, transfer) and the laboratory procedures (culture, biopsy, PGT).

Confirm the authorization names the biopsy code before the biopsy is performed. The embryo count can land on either side of five, so ask the payer to list 89290 and 89291 as alternatives.

Reimbursement rates for CPT Code 89290

Because traditional Medicare does not cover 89290, there is no widely published Medicare Physician Fee Schedule (MPFS) national allowable for this code.

For payers that do cover IVF laboratory services, reimbursement rates are set by contract and vary substantially by region and plan. Many ART laboratory fees are self-pay or run through specialty fertility benefit managers (e.g. Progyny, WINFertility) rather than standard insurance adjudication.

Where a payer does reimburse, the rate can run from several hundred to over a thousand dollars per session, set by each payer contract. 89291 carries its own contracted rate, paid as one unit for the whole session rather than per additional embryo.

No published benchmark replaces the contract, so check each payer’s fee schedule before quoting a patient. The CMS Physician Fee Schedule lookup tool shows whether a national rate exists for 89290 in a given year. It also lists the relative value units (RVUs) assigned to the code.

Documentation requirements for billing CPT Code 89290

The embryology lab record is the primary documentation source for an 89290 claim. Payers that cover ART laboratory services conduct post-payment audits, and thin documentation is a frequent reason for recoupment demands. The record must support five elements.

1. Embryologist’s procedure note: The note records the biopsy date, the embryo stage (cleavage or blastocyst), and the technique (laser, mechanical, chemical). It also records the cells removed per embryo and whether each embryo survived.
2. Embryo count and identifiers: Each embryo must be uniquely labeled in the lab record (e.g. embryo 1, 2, 3). The total count decides the code: 89290 for five or fewer embryos, 89291 for more than five. The lab count must match the code on the claim.
3. Clinical indication / genetics referral: The medical record must document why PGT was ordered, with a note from the reproductive endocrinologist or genetics counselor. This is the document that supports the ICD-10 diagnosis code on the claim.
4. Chain-of-custody documentation: The single most frequently missing element. The record must show the biopsy sample was transferred from the embryology lab to the genetics laboratory under a documented chain-of-custody process. The receiving lab’s receipt or tracking number should be in the patient file. Without this, payers may deny 89290 on the grounds that the biopsy’s clinical purpose (PGT) cannot be confirmed.
5. Cycle documentation linkage: The biopsy record must link to the broader IVF cycle note, with stimulation, retrieval and fertilization dates. The link lets the payer confirm 89290 is part of a covered cycle rather than a standalone procedure.

A structured superbill documentation process captures all five elements at the point of service. That is far more reliable than retrospective chart review before claim submission.

Common claim denial reasons for CPT Code 89290 and how to avoid them

Denial management for 89290 clusters around six root causes. Most are preventable at the point of charge capture rather than through appeals. The remittance names each denial with a reason code, and our guide to medical billing denial codes explains how to read them.

Practices with high denial volumes can build a structured denial management workflow to handle them. It routes 89290 denials to a dedicated ART coding specialist, not the general billing team. Each appeal then goes to someone who knows the code.

The chain-of-custody denial needs the embryology lab record as well as a claim correction. The billing team therefore needs a clear escalation path to the lab team.

Submitting a clean claim the first time requires all six elements to be in place before the claim leaves the practice. Retrospective corrections on ART claims are expensive. An appeal can take weeks to resolve, and the cycle revenue sits in accounts receivable meanwhile.

How Pabau keeps the embryo count accurate from lab to claim

Most 89290 errors start at the handoff between the embryology lab and the billing team. In many fertility centers, the embryologist documents the biopsy in a lab-specific log.

Someone on the billing team then copies the embryo count and code onto the superbill by hand. Each handoff is a chance to miscount embryos, pick the wrong side of the five-embryo line, or miss the chain-of-custody note.

Connecting the clinical encounter directly to charge capture removes that handoff. Pabau, the practice management platform we build, keeps biopsy notes, cycle documentation and ICD-10 codes in the same patient record the coder bills from. The coder sees how many embryos were biopsied and which diagnosis the physician attached, so the right code goes on the claim without retyping.

Pabau’s medical billing software supports structured charge capture for the 89000-series codes, including 89290 and 89291. Completed claims then go out through the Claim.MD clearinghouse, Pabau’s US partner. Eligibility is checked in real time, and claims reach thousands of US payers electronically.

Reduce ART billing errors and claim denials

Pabau connects your embryology lab records to your billing workflow. Your coding team has the right embryo count, diagnosis codes, and cycle documentation before a claim is submitted.

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Conclusion

CPT 89290 rarely fails on the code itself. It fails when the embryo count, the authorization and the chain-of-custody note live in three different places. Bring them together before the next cycle, and most 89290 denials stop before the claim is built.

Start with the authorization. Requesting 89290 and 89291 together costs one extra line on the form and removes the most avoidable denial on this code. Then make the lab’s embryo count the only number the coder bills from.

Pabau helps fertility centers build that handoff into the clinical workflow, so nobody retypes a count between the lab and the claim. Book a demo to see how charge capture and clearinghouse submission would fit your fertility center.

Continue your research

Building the authorization request? The prior authorization process walks through each step from request to approval, including what payers ask for.

Coding a PGT-M carrier indication? ICD-10 Code Z14.8 covers genetic carrier status for a disease without its own carrier code.

Frequently asked questions