Starts with CPT 89320 · AUA/ASRM Guideline Algorithm

Male Infertility Workup CPT Codes

There's no single code for the workup. It starts with the semen analysis, CPT 89320, and every later test — hormones, genetics, culture, the retrograde check — is triggered by a number on that report. Here's the AUA/ASRM algorithm with the code at each branch.

The American Urological Association and the American Society for Reproductive Medicine publish a guideline (2020, amended 2024) that tells physicians which test to order next based on the semen analysis. This page walks that algorithm in order and names the CPT code at each step, so you can read an order, an EOB or a urologist's plan and know where you are. Hera orders step one; a urologist orders the rest.

Semen analysis: $60 physician order + the lab's cash price · later steps are ordered by your urologist, cash ranges listed on each guide

What a male infertility workup is — and why it starts with 89320

A male infertility workup is the sequence of tests a physician uses to find out, from the male side, why a couple isn't conceiving. The AUA/ASRM guideline sets the order: a reproductive history, a physical exam and one or two semen analyses first, then further tests only when a finding calls for them. That's why the semen analysis, CPT 89320 (or 89322 when the lab grades morphology with strict criteria), gates everything else. Hormone testing is triggered by a low count or no sperm; karyotype and Y-chromosome testing by specific concentration cut-offs; a semen culture by round cells; a post-ejaculation urine test by low volume. Every later threshold in the algorithm is a number printed on the semen analysis report.

Because the workup branches, the codes rarely appear on one bill. A lab bills 89320 for the analysis and 87070 if a culture is added; a urologist's office or a reference lab bills 83001 and 84403 for the hormones and 88262 or 81403 for genetics; a fertility clinic may bill 89398 for DNA fragmentation; a surgeon bills 55530 or 55400. On an explanation of benefits (EOB) each shows up as its own line with its own diagnosis code, usually Z31.41 for a first test and an N46.x code once a diagnosis has been made. Knowing the map lets you tell which step you're at, what was skipped, and what a quote actually covers.

The AUA/ASRM algorithm: finding → test and CPT code

  • Not pregnant after 12 months of trying (6 months if your partner is 35 or older), or sooner with a known risk factor such as undescended testes, chemotherapy or a prior fertility problem → reproductive history, physical exam and one or two semen analyses: CPT 89320, or 89322 at labs that use strict morphology, with diagnosis Z31.41. The male partner is evaluated at the same time as the female partner, not after her workup comes back normal.
  • Low sperm count (oligozoospermia), no sperm (azoospermia), low libido or erectile dysfunction → FSH (CPT 83001) and total testosterone (CPT 84403), drawn in the morning. Expert Opinion in the guideline. LH, prolactin and estradiol are added only when those first two results point to it.
  • Azoospermia or a concentration under 5 million/mL → karyotype (CPT 88262) for chromosomal abnormalities such as Klinefelter syndrome (Expert Opinion). Azoospermia or 1 million/mL or less → Y-chromosome microdeletion testing (CPT 81403), Moderate Recommendation, Grade B. Ordered by a urologist or reproductive endocrinologist, usually before any sperm retrieval is planned.
  • No vas deferens felt on exam (congenital bilateral absence of the vas deferens) → CFTR carrier testing (CPT 81220) for the man and, because it often comes with a missing kidney, a renal ultrasound. Expert Opinion. The partner is usually tested for CFTR as well.
  • More than 1 million round cells/mL on the analysis, or a report of pyospermia → the lab first differentiates white blood cells from immature sperm cells; if white cells are confirmed, the physician evaluates for infection and may send a semen culture (CPT 87070). Expert Opinion / Clinical Principle. Round cells alone don't mean infection.
  • Low semen volume (under 1.4 mL) or no ejaculate at all → post-ejaculation urinalysis (CPT 89331) to look for sperm in the urine, the retrograde ejaculation check. Clinical Principle, especially after retroperitoneal surgery, spinal cord injury or with diabetes. Done on the same visit as the semen analysis when possible.
  • Recurrent pregnancy loss with a normal semen analysis, or repeated failed ART cycles → sperm DNA fragmentation testing, billed under the unlisted code CPT 89398. Moderate Recommendation, Grade C. The guideline specifically says not to include it in the initial evaluation.
  • Palpable varicocele, abnormal semen parameters, and a couple trying to conceive → varicocele repair (CPT 55530). Moderate Recommendation, Grade B. Varicoceles found only on ultrasound, with nothing to feel on exam, should not be repaired for fertility.
  • Wants children after a vasectomy → vasectomy reversal (CPT 55400) or surgical sperm retrieval with IVF/ICSI, chosen with the couple based on her age and the years since the vasectomy. Moderate Recommendation, Grade C. Facing chemotherapy or radiation → sperm banking (CPT 89259) before treatment starts, offered to every man of reproductive age.

How to start the workup

1. Order the semen analysis through Hera. No doctor's visit and no lab to pick: the physician order is $60 plus the lab's cash price, and we text or email you the matched location, price and collection instructions within one business day. The order requests the complete analysis (89320) with diagnosis Z31.41.

2. Upload the report. Hera's AI reads every parameter against WHO 2021 reference limits and shows you which guideline thresholds you meet — a count that triggers hormone testing, a concentration under the karyotype or Y-microdeletion cut-offs, round cells that call for a culture, a low volume that calls for the retrograde check.

3. Take that reading to a urologist or reproductive endocrinologist. They order the next codes (83001, 84403, 88262, 81403, 87070, 89331) and decide on repair, reversal or ART. Retest the semen analysis every 3 months while anything is changing — treatment, a varicocele repair, weight, medication — since sperm take about 74 days to develop.

Start with step one — we'll match you to a lab

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Male infertility workup CPT and ICD-10 codes

These are the codes the guideline algorithm can generate, in roughly the order they appear. Only the first line is a Hera order; the rest are ordered by a urologist, reproductive endocrinologist or fertility clinic when a finding calls for them. If a plan or a quote lists anti-sperm antibodies (89325), a scrotal ultrasound or a testicular biopsy up front, ask why — the guideline does not recommend them routinely.

CPT codes (what the lab runs)

CodeWhat it covers
89320 (Start here)Complete semen analysis — step one of every male infertility workup; every later threshold is a number from this test.
89322The same analysis with strict (Kruger) morphology — what fertility-clinic and andrology labs bill.
83001FSH — with testosterone, the first-line hormone test for low count, no sperm, low libido or erectile dysfunction.
84403Total testosterone — drawn in the morning, alongside FSH.
88262Karyotype — for azoospermia or a concentration under 5 million/mL.
81403Y-chromosome microdeletion — for azoospermia or a concentration of 1 million/mL or less.
87070Semen culture — when white blood cells or more than 1 million round cells/mL are seen.
89331Post-ejaculation urinalysis — for low or zero semen volume, to check for retrograde ejaculation.
89325Anti-sperm antibodies — not in the initial evaluation; added on specific findings.
89398Sperm DNA fragmentation (unlisted code) — for recurrent pregnancy loss, not up front.
55530Varicocele repair — palpable varicocele plus abnormal parameters in a couple trying to conceive.
55400Vasectomy reversal — one of two guideline options for fatherhood after vasectomy.
89259Sperm freezing — before chemotherapy, radiation or surgery that can damage sperm production.

Diagnosis codes physicians commonly use (ICD-10)

CodeWhat it covers
Z31.41 (Start here)Encounter for fertility testing — the diagnosis on a first semen analysis.
N46.9Male infertility, unspecified — once infertility is being worked up.
N46.01Organic azoospermia — no sperm; triggers hormone and genetic testing.
N46.11Organic oligospermia — low count; triggers hormone testing, and genetic testing under 5 million/mL.
N46.8Other male infertility — abnormal motility or morphology with a normal count.

Coverage follows the diagnosis code. Z31.41, encounter for fertility testing, is what a first semen analysis carries; once a result is abnormal, physicians code N46.01 (azoospermia), N46.11 (oligospermia), N46.8 or N46.9, and those infertility codes are exactly what many plans exclude. Ask each ordering office which diagnosis they'll use before the genetic tests, which are the expensive ones. Hera confirms the lab's cash price for the semen analysis before your visit; cash ranges for the later tests are on each test's own guide.

Male Infertility Workup CPT Code FAQ

What is the CPT code for a male infertility workup?

There isn't a single one. A male infertility workup is a sequence, and it starts with the complete semen analysis, CPT 89320 (89322 when the lab uses strict morphology). What gets billed after that depends on the result: FSH 83001 and testosterone 84403 for a low count, karyotype 88262 and Y-chromosome microdeletion 81403 for very low or zero counts, a semen culture 87070 for round cells, a post-ejaculation urine test 89331 for low volume. Many men never get past the first step or two.

Which tests does the AUA/ASRM guideline recommend first?

A reproductive history, a physical exam by a specialist, and at least one semen analysis; a second is recommended when the first is abnormal, since results vary from sample to sample. Nothing else is routine at the first visit. Hormones, genetics, culture and imaging are all triggered by what the history, the exam or the semen analysis shows.

When are hormone tests (FSH, testosterone) added?

When the semen analysis shows a low concentration or no sperm, or when the man has low libido, erectile dysfunction or other signs of low testosterone. The first panel is FSH (83001) and a morning total testosterone (84403). If testosterone is low, LH and prolactin follow; estradiol is added when obesity or gynecomastia suggests it. A normal count with no symptoms doesn't need hormone testing.

When is genetic testing needed in a male infertility workup?

At two thresholds on the semen analysis. A karyotype (88262) is recommended for azoospermia or a concentration under 5 million/mL. Y-chromosome microdeletion testing (81403) is recommended for azoospermia or a concentration of 1 million/mL or less. CFTR carrier testing (81220) is added when the vas deferens is absent on exam. The results change what treatment is offered — some Y-chromosome deletions mean sperm retrieval won't succeed — so they're done before surgery, not after.

Does insurance cover a male infertility workup?

It depends on the diagnosis code more than on the test. A first semen analysis usually goes in as Z31.41, encounter for fertility testing. Once infertility is diagnosed the codes become N46.01, N46.11, N46.8 or N46.9, and many US plans exclude infertility diagnosis and treatment entirely, while others cover diagnosis but not treatment. Some states mandate a degree of infertility coverage. Ask each ordering office which diagnosis code they'll use, and check your plan's infertility clause before the genetic tests, which are the expensive ones.

How often should the semen analysis be repeated?

The guideline calls for a second analysis when the first is abnormal, ideally a few weeks apart with the same abstinence period at the same lab. After that, retest about every 3 months while anything is changing — a varicocele repair, a medication, weight loss, quitting smoking or heat exposure — because sperm take roughly 74 days to develop, so a change today shows up on a report about 3 months later. Use the same CPT code (89320 or 89322) each time so results compare like for like.

What does the guideline say not to do?

Several things that still show up on orders. Anti-sperm antibody testing (89325) isn't recommended in the initial evaluation. Scrotal ultrasound isn't routine — a varicocele that matters is one the clinician can feel. Transrectal ultrasound or MRI is reserved for suspected ejaculatory-duct obstruction. A diagnostic testicular biopsy isn't done just to make a diagnosis. Sperm DNA fragmentation isn't part of the initial workup. And men who want to conceive shouldn't be given exogenous testosterone, which shuts down sperm production. If a plan includes these up front, ask what finding prompted them.

Do I need a urologist to start the workup?

No. The semen analysis is the first step for every man, and you don't need a referral to get one: Hera's physician issues the order and matches you to a lab. The numbers on that report decide whether you need a specialist at all — a normal analysis with no risk factors often closes the male side of the evaluation, while a low count, no sperm, low volume or round cells means booking a urologist or reproductive endocrinologist for the next codes. Bring the report and the AI reading with you.