ASRM PGT Billing: Coding 89290, 89291, and the Biopsy-to-Transfer Chain

Preimplantation genetic testing (PGT) is one of the most complex billing scenarios in reproductive medicine — not because the individual codes are difficult, but because billing PGT correctly requires coordinating codes across three distinct phases: the embryo biopsy (performed at the IVF practice), the genetic analysis (performed at a third-party genetics lab), and the subsequent frozen embryo transfer cycle (performed back at the IVF practice). ASRM has published guidance on PGT — covering PGT-A (aneuploidy screening), PGT-M (monogenic disease), and PGT-SR (structural rearrangements) — that informs how each phase should be coded.

ASRM's Published Guidance on PGT

ASRM's Practice Committee has published multiple opinions on PGT, addressing clinical indications, patient selection criteria, and laboratory standards. From a billing perspective, the most relevant guidance is ASRM's position that PGT-A, PGT-M, and PGT-SR are distinct procedures with different clinical indications — a distinction that matters for ICD-10 code selection and authorization requests. ASRM also recognizes the embryo biopsy as a distinct laboratory service from the genetic analysis itself, which supports separate billing of biopsy codes (89290/89291) from the genetics lab codes (81228, 81229, 81479).

Embryo Biopsy Codes: 89290 vs. 89291

CPT 89290 and 89291 both describe trophectoderm biopsy of embryos for preimplantation genetic testing. The distinction is embryo count: 89290 is used when fewer than 5 embryos are biopsied in a single session; 89291 is used when 5 or more embryos are biopsied. These codes are billed by the IVF practice (under the embryology lab NPI if applicable) and should appear on the claim for the biopsy session — not the transfer cycle.

The Genetics Lab Analysis Codes

The genetic analysis of biopsied embryo material is performed by a third-party PGT laboratory — not the IVF practice. These services are billed by the genetics lab under its own NPI and tax ID, using molecular pathology codes from the 81xxx series. The IVF practice's biopsy codes (89290/89291) and the genetics lab's analysis codes are complementary, not mutually exclusive — both are billable for the same PGT cycle, by different billing entities.

Authorization Requirements for PGT

PGT prior authorization is among the most variable and documentation-intensive in fertility billing. Most commercial plans that cover PGT require a separate authorization from the IVF cycle authorization — and that authorization must specify the type of PGT (A, M, or SR), the genetic indication, the laboratory performing the analysis, and sometimes the specific number of embryos to be biopsied. Authorization obtained for IVF will not cover PGT biopsy codes unless they are explicitly listed. Failure to list 89290 or 89291 in the authorization is the most common reason these codes deny.

Coordination Between the IVF Practice and the Genetics Lab

• Confirm before the cycle whether the patient has separate authorization for the PGT lab component — the genetics lab will have its own authorization requirements from the same or different payer.
• Verify that the PGT laboratory is in-network under the patient's plan. Out-of-network genetics lab billing is a common source of unexpected patient balances in PGT cycles.
• Clarify with the genetics lab which codes they will bill and for which services — avoid accidental double-billing for services that could be attributed to either entity.
• Obtain a copy of the genetics lab's authorization (or confirmation that they have obtained it) before the biopsy session proceeds.

The FET Cycle Following PGT

A PGT cycle always produces a frozen embryo transfer as the next clinical step — the biopsied embryos must be vitrified while awaiting genetics results. The subsequent FET cycle is billed with the same codes as any FET: 89352 (embryo thaw), 58976 (frozen embryo transfer), and the appropriate endometrial monitoring codes. The FET following PGT requires its own prior authorization — separate from the IVF cycle authorization and the PGT biopsy authorization. Aligning the FET authorization to the correct cycle and confirming that remaining benefit allows for the transfer are essential billing steps that are frequently missed.

ASRM's guidance on PGT supports billing the biopsy, the genetic analysis, and the subsequent transfer as distinct services at each phase. Implementing that guidance across a three-entity billing chain — IVF practice, genetics lab, and the FET billing cycle — requires careful coordination that most general billing teams are not equipped to manage.