CPT 89331 · Sperm in Post-Ejaculation Urine
89331 is the post-ejaculation urine test: it checks whether semen is going backward into the bladder instead of out. It's billed alongside the semen analysis when volume is low or absent. Here's what it covers, when it's ordered, and how to get it done.
Retrograde ejaculation means the bladder neck doesn't close during orgasm, so some or all of the semen flows into the bladder. The tell-tale signs are a very small or dry ejaculate and cloudy urine afterward. CPT 89331 is the lab test that confirms it by finding sperm in urine collected right after ejaculation. Order a semen analysis through Hera and the report shows your volume; if it's low, this is the next step.
$60 physician order + the lab's cash price for the semen analysis (roughly $75–$300), confirmed before your visit
CPT 89331 is a sperm evaluation on urine collected immediately after ejaculation, ordered when retrograde ejaculation is suspected. You empty your bladder, produce a semen sample as usual, then urinate into a second container. The lab spins the urine down and examines it for sperm, reporting how many were found and, when there are enough, their motility and morphology. Sperm in that urine means at least part of the ejaculate went into the bladder.
It's almost always billed with the complete semen analysis (CPT 89320) on the same visit, because you need both numbers: what came out, and what went back. Two related codes turn up further down the road. CPT 89260 is a simple sperm wash, used when sperm recovered from the urine are prepared for intrauterine insemination. CPT 55870, electroejaculation, is a treatment rather than a test, used when there's no ejaculate at all, typically after spinal cord injury.
1. Place a semen analysis order with Hera. Tell us where you are and we match you to a lab near you, send the physician-signed order, and text or email you the location, cash price and collection instructions within one business day. If you already know your volume is low or absent, tell us in the order notes so we can steer you to a lab that runs post-ejaculation urine testing.
2. At the lab, collect the full sample after 2 to 7 days of abstinence and tell the staff if any of it spilled. If your volume comes back under 1.4 mL, ask the lab whether it can add a post-ejaculation urine test (CPT 89331) on a repeat visit, or take the report to a urologist who can order it with N53.14.
3. Upload the report and Hera's AI reads volume alongside count, motility and morphology against WHO 2021 limits and flags low volume specifically, so you know whether retrograde ejaculation is worth ruling out before you spend on anything else.
The semen analysis is the first step: it tells you whether volume is actually the problem. Submit your order and we match you to a lab. Want to understand your volume number first? Read what low semen volume means.
Order a semen analysis — we'll match you to a lab What low semen volume meansEvery lab order carries a CPT code (what the lab runs) and an ICD-10 diagnosis code (why it was ordered). If you bring your own order, or want to check what your insurance will see, these are the codes to look for.
| Code | What it covers |
|---|---|
| 89331 (Add-on ordered by a urologist) | Sperm evaluation in urine collected right after ejaculation — count, motility and morphology as needed. The post-ejaculatory urinalysis for suspected retrograde ejaculation. |
| 89320 | Complete semen analysis — usually run at the same visit, on the ejaculate itself. |
| 89260 | Simple sperm wash and preparation — used when sperm recovered from urine are prepared for insemination. |
| 55870 | Electroejaculation — a treatment option when there is no ejaculate at all, not a diagnostic test. |
| Code | What it covers |
|---|---|
| N53.14 (Add-on ordered by a urologist) | Retrograde ejaculation — semen entering the bladder instead of leaving the body. |
| N46.8 | Other male infertility — when low volume or aspermia is part of an infertility workup. |
| Z31.41 | Encounter for fertility testing. |
Because N53.14 is a specific diagnosis rather than a fertility screen, a post-ejaculation urine test is more often covered than a semen analysis billed with Z31.41. Cash prices for 89331 vary widely between labs and it's usually quoted as an add-on to the analysis, so ask for both prices together. Hera confirms the lab's semen analysis price before your visit.
CPT 89331, a sperm evaluation on urine collected right after ejaculation. The lab centrifuges the urine and looks for sperm; finding them confirms that semen is entering the bladder. It's normally billed together with the complete semen analysis, CPT 89320, on the same visit.
N53.14, retrograde ejaculation, once it's suspected or confirmed. Before that, physicians use N46.8, other male infertility, when low volume is already documented, or Z31.41, encounter for fertility testing, when the urine test is part of the initial workup.
You urinate first to empty the bladder, produce the semen sample as usual, then urinate again into a separate sterile cup. Both containers go to the lab. Some labs ask you to take sodium bicarbonate beforehand so the urine is less acidic and any sperm survive long enough to be counted or used. Follow the lab's specific instructions.
Anything that stops the bladder neck from closing during orgasm: prostate or bladder-neck surgery such as a TURP, retroperitoneal lymph node dissection for testicular cancer, nerve damage from long-standing diabetes or spinal cord injury, and medications, most often alpha-blockers like tamsulosin used for urinary symptoms. Sometimes no cause is found.
Yes, in specific situations. The 2020 guideline (amended 2024) states that clinicians should obtain a post-orgasmic urinalysis in men with aspermia after retroperitoneal lymph node dissection, and it's standard practice for low-volume or absent ejaculate more generally once collection problems are ruled out. For aspermia the guideline notes that clinicians may use induced ejaculation, meaning sympathomimetic medication, vibratory stimulation or electroejaculation, or surgical sperm extraction, to obtain sperm for treatment.
55870 is electroejaculation, a procedure done under anesthesia that triggers ejaculation with a rectal probe. It's a treatment option, not a test, for men who can't ejaculate at all, most often after spinal cord injury, and is usually done at a fertility center so the sample can be used for IUI or IVF right away. It appears here because it sits on the same care pathway as 89331 when the urine test finds no sperm either.
Often, yes. If medication such as pseudoephedrine or imipramine doesn't restore forward ejaculation, sperm recovered from alkalinized post-ejaculation urine can be washed (CPT 89260) and used for intrauterine insemination, or for IVF with ICSI when numbers are low. Retrograde ejaculation is one of the more treatable causes of a low count, which is why it's worth confirming before anything else.