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See a sample rate comparisonCPT 89254 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Fertility Procedure, Laboratory Procedure To Help Induce A Pregnancy Through In-Vitro Fertilization Or Another Infertility Treatment Technique.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Reproductive Medicine Procedures |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | 59 - Distinct Procedural Service V1 |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 89254 |
National average reimbursement for CPT 89254 by major payers:
$497.91
$55.00
$401.62
$923.87
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CPT 89254
5 of 25 sample ratesHigher to lower in this preview
Lynn Simpson
Columbia University In The City Of New York
$853.36Published rateSahar Stephens
Northern California Fertility Medical Center
$440.00Published rateKeith Gresham
$180.00Published rateJames Lyons
Springfield Hospital Inc
$140.00Published rateKathryn Miele
Memorial Hospital
$77.56Published rate
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See a sample payer proposalCPT 89254 vs. Other Reproductive Medicine Procedures Codes
The CPT 89254 code is part of the Pathology and Laboratory Procedures services used for Reproductive Medicine Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 89254 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 89250-CPT | Moderate | Fertility Procedure, Laboratory Procedure To Help Induce A Pregnancy Through In-Vitro Fertilization Or Another Infertility Treatment Technique. |
| 89251-CPT | Moderate | Fertility Procedure, Laboratory Procedure To Help Induce A Pregnancy Through In-Vitro Fertilization Or Another Infertility Treatment Technique. |
| 89253-CPT | Moderate | Fertility Procedure, Laboratory Procedure To Help Induce A Pregnancy Through In-Vitro Fertilization Or Another Infertility Treatment Technique. |
| 89254-CPT | Moderate | Fertility Procedure, Laboratory Procedure To Help Induce A Pregnancy Through In-Vitro Fertilization Or Another Infertility Treatment Technique. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 89254. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 89254 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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