Change to HMO Blue® Texas Outpatient Clinical Reference Lab Services Effective December 1, 2008
The following change will be implemented to the HMO Blue Texas Outpatient Clinical Reference Lab Services effective December 1, 2008:
- The following twelve (12) Test Descriptions & CPT codes will be added to the Reimbursable Lab Services List:
| Test Description | CPT Code |
| Culture of oocyte(s)/embryo(s), less than 4 days | 89250 |
| Assisted embryo hatching, microtechniques (any method) | 89253 |
| Oocyte identification from follicular fluid | 89254 |
| Preparation of embryo for transfer (any method) | 89255 |
| Sperm identification from aspiration (other than seminal fluid) |
89257
|
| Sperm isolation; complex prep (eg, Percoll gradient, albumin gradient) for insemination or diagnostic with semen analysis |
89261
|
| Sperm identification from testis tissue, fresh or cryopreserved |
89264
|
| Insemination of oocytes |
89268
|
| Extended culture of oocyte(s)/embryo(s), 4-7 days | 89272 |
| Assisted oocyte fertilization, microtechnique: less than or equal to 10 oocytes | 89280 |
| Assisted oocyte fertilization, microtechnique: greater than 10 oocytes | 89281 |
| Thawing of cryopreserved; embryo(s) | 89352 |
Note: HMO Blue Texas physicians/professional providers who are contracted/affiliated with a capitated independent practice association (IPA) or medical group, must contact the IPA/medical group for information regarding any additional authorization requirements.
