| Change to HMO Blue® Texas Outpatient Clinical Reference Lab Services Effective December 1, 2008 |
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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 |
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| 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 |
View the updated HMO Blue Texas Outpatient Clinical Reference Lab Services effective December 1, 2008.
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.
posted 9/23/08
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