Download Top 25 IVF CPT Codes Worksheet worksheet Use our free worksheet on IVF CPT codes to streamline your fertility clinic billing Download worksheet Key Takeaways CPT codes 58970 (egg retrieval) and 58974 (embryo transfer) are the core surgical codes for IVF cycles Laboratory codes like 89250-89268 cover embryo culture, identification, and insemination procedures ICSI billing uses 89280 for 10 or fewer oocytes and 89281 for more than 10 oocytes Understanding bundled vs unbundled billing prevents claim denials and compliance issues Annual CPT code updates from the AMA can affect fertility billing, so verify codes each year Accurate billing is essential for fertility clinics. Whether you work in a large reproductive medicine centre or a private fertility practice, understanding IVF CPT codes helps ensure proper reimbursement and compliance. This guide covers the CPT codes used throughout the IVF process, from initial evaluation to embryo transfer and cryopreservation. What are CPT codes for IVF treatment? CPT (Current Procedural Terminology) codes are standardised medical codes developed and maintained by the American Medical Association (AMA). These five-digit codes describe the medical, surgical, and diagnostic services provided to patients. For fertility clinics, CPT codes communicate the specific procedures performed during IVF treatment to insurance payers. When you submit a claim to an insurance company, CPT codes tell the payer exactly what services were rendered. Each code corresponds to a defined procedure with established reimbursement rates. Even if your fertility clinic operates on a self-pay basis, CPT codes remain important. Patients who want to seek reimbursement from their insurance carriers need a superbill with accurate CPT codes. Providing incorrect codes can result in claim denials for your patients or potential compliance issues for your practice. Common IVF evaluation CPT codes Before starting an IVF cycle, patients undergo consultations and diagnostic evaluations. These visits use standard evaluation and management (E/M) codes along with imaging codes. Code Description Typical Use 99203 New patient office visit, low complexity Initial fertility consultation (straightforward cases) 99204 New patient office visit, moderate complexity Initial consultation with detailed history review 99205 New patient office visit, high complexity Complex cases requiring comprehensive evaluation 99213 Established patient visit, low complexity Follow-up appointments, routine monitoring 99214 Established patient visit, moderate complexity Cycle monitoring with treatment adjustments 99215 Established patient visit, high complexity Complex follow-up requiring extended discussion 76830 Transvaginal ultrasound, non-obstetric Follicle monitoring, baseline scans 76857 Pelvic ultrasound, limited General pelvic assessment During controlled ovarian stimulation, patients typically have multiple monitoring visits using 99213 or 99214 combined with 76830 for follicle tracking. Efficient appointment scheduling becomes critical when managing frequent monitoring visits. IVF procedure CPT codes (surgical) The surgical components of IVF involve egg retrieval and embryo transfer. These procedures have specific CPT codes that reflect the technical nature of the work. CPT code 58970 – Follicle puncture for oocyte retrieval, any method This code covers the egg retrieval procedure, where follicles are aspirated transvaginally under ultrasound guidance. It includes the aspiration of all follicles during the procedure, regardless of the number retrieved. CPT code 58974 – Embryo transfer, intrauterine This code is used for transferring embryos into the uterine cavity. It applies to both fresh and frozen embryo transfers. The code covers the transfer procedure itself, not the preparation of embryos. CPT code 58976 – Gamete, zygote, or embryo intrafallopian transfer, any method This code applies to GIFT (gamete intrafallopian transfer) or ZIFT (zygote intrafallopian transfer) procedures, where gametes or embryos are placed directly into the fallopian tube. These procedures are less common today but still performed in specific clinical situations. When billing these procedures, modifiers may apply. For example, modifier -26 indicates the professional component only, while modifier -TC indicates the technical component. Some payers require modifier -59 to indicate a distinct procedural service when multiple procedures are performed on the same day. IVF laboratory CPT codes The embryology laboratory performs multiple procedures during an IVF cycle. Each has a corresponding CPT code. CPT code 89250 – Culture of oocyte(s)/embryo(s), less than 4 days This code covers the initial culture period after egg retrieval. It includes maintaining the oocytes and resulting embryos in controlled laboratory conditions through day 3 of development. CPT code 89251 – Culture of oocyte(s)/embryo(s), 4-7 days (extended culture) When embryos are cultured to the blastocyst stage (day 5-7), this code is used instead of or in addition to 89250. Extended culture allows for better embryo selection before transfer. CPT code 89253 – Assisted embryo hatching, microtechnique Assisted hatching involves creating a small opening in the zona pellucida to help the embryo implant. This procedure is often performed on embryos from older patients or those with previous implantation failure. CPT code 89254 – Oocyte identification from follicular fluid After aspiration, embryologists examine follicular fluid to identify and isolate oocytes. This code covers the identification process for all oocytes retrieved during a cycle. CPT code 89255 – Preparation of embryo for transfer This code covers the final preparation of embryos immediately before transfer, including loading the embryo into the transfer catheter. CPT code 89268 – Insemination of oocytes Standard insemination involves placing sperm around the oocytes and allowing natural fertilisation. This code applies to conventional IVF without ICSI. ICSI (intracytoplasmic sperm injection) CPT codes ICSI is a specialised fertilisation technique where a single sperm is injected directly into each oocyte. This method is commonly used for male factor infertility, previous fertilisation failure, or when using frozen sperm. CPT code 89280 – Assisted oocyte fertilisation, microtechnique; 10 or fewer oocytes Use this code when performing ICSI on 10 or fewer mature oocytes. This is the more common code, as many cycles yield 10 or fewer eggs suitable for ICSI. CPT code 89281 – Assisted oocyte fertilisation, microtechnique; greater than 10 oocytes When more than 10 oocytes undergo ICSI, this code applies instead of 89280. The higher code reflects the additional time and technical work required. The choice between ICSI (89280/89281) and conventional insemination (89268) depends on clinical factors. ICSI is typically indicated for severe male factor infertility, prior fertilisation failure, or when using surgically retrieved sperm. You cannot bill both conventional insemination and ICSI for the same oocytes. Cryopreservation CPT codes Cryopreservation allows fertility clinics to freeze eggs, sperm, and embryos for future use. Each type of cryopreservation has a specific code. CPT code 89258 – Cryopreservation; embryo(s) This code covers freezing embryos, regardless of the number frozen in a single cycle. It includes the vitrification or slow-freeze process and initial storage preparation. CPT code 89259 – Cryopreservation; sperm Sperm freezing uses this code. It applies whether freezing ejaculated sperm or surgically retrieved sperm samples. CPT code 89337 – Cryopreservation; oocyte(s) Egg freezing for fertility preservation uses this code. It covers the freezing process for all oocytes preserved in a single cycle. For thawing frozen reproductive tissue, the following codes apply: 89352 – Thawing of cryopreserved; embryo(s) 89353 – Thawing of cryopreserved; sperm/semen, each aliquot 89354 – Thawing of cryopreserved; reproductive tissue Note that annual storage fees are typically facility charges, not CPT-coded services. These fees are billed separately from the cryopreservation procedure itself. Genetic testing (PGT) CPT codes Preimplantation genetic testing (PGT) involves removing cells from embryos for genetic analysis. The biopsy procedure and the genetic analysis are usually billed separately. CPT code 89290 – Biopsy, oocyte polar body or embryo blastomere, microtechnique This code covers the embryo biopsy procedure, where cells are removed from the trophectoderm for genetic analysis. The code applies regardless of the number of embryos biopsied. The genetic analysis itself uses molecular pathology codes, which vary based on the type of testing: PGT-A (aneuploidy screening) uses codes from the 81228-81229 range or proprietary lab codes PGT-M (monogenic disorder testing) uses gene-specific molecular codes PGT-SR (structural rearrangements) uses chromosomal analysis codes In most cases, the fertility clinic bills for the biopsy (89290) while the genetics laboratory bills separately for the analysis. Clarify with your genetics lab partner which codes they will bill to avoid duplicate charges. Understanding bundled vs unbundled IVF billing Fertility clinics typically choose between two billing approaches: global (bundled) fees or itemised (unbundled) billing. Global fee billing packages multiple services into a single charge. For example, a clinic might offer a "fresh IVF cycle" package that includes monitoring, retrieval, laboratory services, and transfer for one price. This approach simplifies patient billing and can make costs more predictable. Itemised billing charges separately for each CPT-coded service. This approach provides detailed documentation of services rendered and may be required by some insurance payers. The National Correct Coding Initiative (NCCI) establishes rules about which codes can be billed together. Some code pairs are considered bundled, meaning one code includes the services of another. Billing both codes separately would be incorrect. Common bundling considerations for IVF: Embryo culture codes (89250, 89251) may have restrictions on same-day billing ICSI (89280/89281) and conventional insemination (89268) cannot be billed for the same oocytes Evaluation codes may be bundled with procedures performed on the same day Check NCCI edits and payer-specific policies before establishing your billing practices. Unbundling services that should be bundled can result in compliance issues and claim denials. Pro Tip Keep a reference sheet of your most common CPT code combinations and their NCCI edit status. Review it quarterly when CMS releases updates to catch any changes that affect your billing. IVF CPT code billing tips Following best practices helps ensure clean claims and proper reimbursement. Document medical necessity for each procedure in the client record. Insurance payers may request documentation to support claims, particularly for services like ICSI or assisted hatching. Verify codes annually. The AMA updates CPT codes each January. Subscribe to AMA updates or use a billing service that tracks changes to avoid using deleted or modified codes. Check payer-specific requirements. Different insurance companies may have varying documentation requirements, prior authorisation needs, or coverage limitations for fertility services. Link diagnosis codes correctly. IVF CPT codes should be paired with appropriate ICD-10 diagnosis codes (N97.x for female infertility, N46.x for male factor) to support medical necessity. Submit claims promptly. Most payers have timely filing limits. Submitting claims quickly also accelerates your revenue cycle. Track denials and patterns. If certain codes are frequently denied, review your documentation practices or contact the payer for clarification. Where can I find more information about IVF CPT codes? Several professional organisations and government resources provide guidance on fertility billing. The American Society for Reproductive Medicine (ASRM) offers coding resources for members, including updates on CPT changes affecting reproductive medicine. The Society for Assisted Reproductive Technology (SART) provides practice management resources that include billing guidance for member clinics. CMS (Centers for Medicare and Medicaid Services) publishes the Medicare Physician Fee Schedule and NCCI edits. While most IVF patients are not Medicare beneficiaries, these resources establish baseline billing standards that commercial payers often follow. State fertility mandates also affect billing. Currently, 20 US states have laws requiring some level of fertility coverage. Understanding your state's mandate helps determine which services may be covered for your patients. How to use IVF CPT codes with your EMR Modern practice management software streamlines CPT code selection and claim submission. An integrated EMR system designed for fertility practices can reduce billing errors and accelerate reimbursement. Key features to look for include: Code libraries with fertility-specific CPT codes pre-loaded Automatic code suggestions based on documented procedures Claim scrubbing to catch errors before submission Denial management tools to track and resolve rejected claims Reporting on reimbursement rates by code and payer Using clinic management software ensures that your billing workflow matches your clinical workflow. When procedure documentation flows directly into claim generation, you reduce manual entry errors and speed up your revenue cycle. Features like digital forms for consent documentation, integrated calendar management for monitoring appointments, and payment processing for patient collections work together to create a seamless experience from consultation to claim submission. “Pabau has transformed how we handle billing across our fertility services. The integrated system means our embryology lab codes and physician charges stay perfectly aligned, reducing our claim denial rate significantly.” Camille Armstrong Founder / Co-Owner, Secret Enhancements Expert Picks Struggling with insurance claim denials? Learn how claims management software can automate submissions and reduce errors. Want to connect clinical notes directly to billing? See how the best EMR software integrates documentation with coding workflows. Running a multi-location fertility practice? Explore strategies for managing multiple clinic locations efficiently. FAQs What CPT code is used for egg retrieval? CPT code 58970 (Follicle puncture for oocyte retrieval, any method) is used for the egg retrieval procedure. This code covers the transvaginal aspiration of follicles regardless of the number of eggs retrieved. Is IVF covered by insurance? Coverage varies significantly by state and insurance plan. Twenty US states have fertility coverage mandates, though the specifics of what must be covered differ. Many employer-sponsored plans exclude IVF, while others provide partial or full coverage. Always verify benefits with the patient's specific insurance plan before treatment. What's the difference between 89280 and 89281? Both codes cover ICSI (intracytoplasmic sperm injection), but they differ based on oocyte count. Use 89280 when performing ICSI on 10 or fewer oocytes. Use 89281 when performing ICSI on more than 10 oocytes. You should only bill one of these codes per cycle, not both. How do I bill for frozen embryo transfer (FET)? A frozen embryo transfer cycle typically includes: 58974 (embryo transfer), 89352 (thawing of cryopreserved embryos), and possibly 89250 or 89251 if additional culture is performed after thawing. Monitoring visits and ultrasounds are billed separately with the appropriate E/M and imaging codes. What modifiers are used with IVF codes? Common modifiers for IVF billing include: -26 (professional component only), -TC (technical component only), -59 (distinct procedural service), and -50 (bilateral procedure). Modifier usage depends on your practice setup and payer requirements. Always verify modifier policies with each insurance company.
