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)
Sperm isolation; complex prep (eg, Percoll gradient, albumin gradient) for insemination or diagnostic with semen analysis
Sperm identification from testis tissue, fresh or cryopreserved
Insemination of oocytes
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.