Sperm analysis

Sperm analysis is a laboratory test that assesses semen quality by measuring sperm count, motility, and morphology. Health insurance policies from Aetna and Blue Cross may cover sperm analysis when required for infertility diagnosis, as per their medical necessity criteria.

Medicare classifies sperm analysis as a diagnostic procedure but excludes coverage unless linked to an underlying medical condition like azoospermia. The CPT code 89220 applies to standard sperm analysis and guides reimbursement in most private plans.

Plans from Cigna or UnitedHealthcare often require a doctor’s referral before approving coverage for sperm analysis. Out-of-pocket cost for uninsured individuals ranges from $100 to $400 per test at clinics in cities such as Chicago or Los Angeles.

FSA and HSA accounts can reimburse costs of medically necessary sperm analyses, subject to IRS guidelines, per Your Insurance Info. Denials occur if insurers classify sperm analysis as part of elective fertility treatment rather than diagnostics, referencing policy exclusions.

Sperm analysis results become part of the patient’s protected health information (PHI), regulated by HIPAA in contexts including billing and sharing with reproductive specialists. Claims require submission of documentation from urologists or reproductive endocrinologists who order the sperm analysis for evaluation of male factor infertility.