PGT Billing: A Complete Guide to Preimplantation Genetic Testing Reimbursement

Preimplantation genetic testing (PGT) billing is one of the most technically demanding areas in fertility revenue cycle management. It requires coordinating billing across three separate entities — the fertility clinic, the in-house or contracted embryology lab, and the third-party reference genetics laboratory — each of which bills for distinct components of the testing service. When any entity bills the wrong codes, or when billing overlaps between entities, the result is duplicate claim denials, post-payment audits, or patient balance disputes.

PGT-A vs. PGT-M: Key Billing Differences

PGT-A (preimplantation genetic testing for aneuploidy) and PGT-M (for monogenic disease) use different analysis methodologies and therefore carry different CPT codes at the genetics reference lab level. PGT-A typically involves chromosomal microarray analysis billed under 81228 or 81229. PGT-M involves assay design and analysis that varies by the specific mutation being tested — there is no single universal CPT code for PGT-M, and many genetics labs use unlisted molecular pathology codes (81479) for PGT-M services. Billing teams must obtain the specific code set from their genetics reference lab before submitting claims.

Clinic-Side PGT CPT Codes

• 89290 — Biopsy, oocyte polar body or embryo blastomere, for preimplantation diagnosis; less than or equal to 5 embryos
• 89291 — Biopsy, oocyte polar body or embryo blastomere, for preimplantation diagnosis; greater than 5 embryos
• 89258 — Cryopreservation; embryo(s) (used when embryos are vitrified pending genetic results)
• 58661 or 58670 — Not used for PGT biopsy; biopsy codes are from the 89xxx series only

Authorization Requirements for PGT

When a payer covers PGT services, prior authorization is almost always required — and authorization must typically cover both the biopsy codes (clinic-side) and the analysis codes (genetics lab-side). Many payers require a separate authorization for the reference lab's services. Failure to obtain authorization for the analysis component is the single most common reason PGT claims deny, because the genetics reference lab submits weeks after the biopsy, and the authorization obtained for the retrieval cycle may not extend to the analysis codes.

Coordinating Billing Between Clinic and Reference Lab

• Establish a written agreement with the reference genetics lab specifying which entity bills which CPT codes.
• Do not bill genetic analysis codes (81228, 81229, 81479) on the clinic's claim — these belong on the reference lab's claim.
• Educate patients before the cycle that they will receive two separate bills — one from the clinic and one from the genetics lab.
• Confirm whether the reference lab is in-network with the patient's plan before the cycle begins.
• Audit PGT claims quarterly against reference lab remittances to identify any code overlap.