Summary & Overview
CPT 80402: ACTH Stimulation Test for Adrenal Function
CPT code 80402 denotes an ACTH stimulation test, a diagnostic endocrine procedure that assesses adrenal gland function by measuring cortisol response to synthetic adrenocorticotropic hormone. Nationally, this test is an important tool for diagnosing primary and secondary adrenal insufficiency and for guiding endocrine management across outpatient and hospital settings. It carries clinical significance for endocrinologists, primary care clinicians, and inpatient teams evaluating suspected adrenal disorders.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 80402, typical sites of service, and the service type. The publication also outlines payer coverage considerations, common billing modifiers associated with laboratory and diagnostic services where available, and links to related procedural coding where applicable. Practical information includes benchmarks and billing practice highlights relevant to clinicians, coding professionals, and revenue cycle teams.
This summary is intended for a national audience. It provides a clear clinical and billing framing for CPT code 80402 so stakeholders can align documentation, ordering, and billing practices with the clinical purpose of the ACTH stimulation test.
Billing Code Overview
CPT code 80402 represents an ACTH stimulation test, a diagnostic endocrine procedure used to evaluate adrenal gland function by measuring cortisol response after administration of synthetic adrenocorticotropic hormone (ACTH). This test is ordered and interpreted by endocrinologists and other clinicians managing suspected adrenal insufficiency or disorders of the hypothalamic-pituitary-adrenal axis.
Service type: Endocrinology diagnostic laboratory test
Typical site of service: Outpatient clinic, endocrinology clinic, or hospital outpatient laboratory
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Clinical & Coding Specifications
Clinical Context
A 45-year-old woman with progressive fatigue, weight loss, orthostatic dizziness, and hyperpigmentation presents to an endocrinology clinic. The endocrinologist suspects primary or secondary adrenal insufficiency and orders an ACTH stimulation test to evaluate adrenal cortisol reserve. The patient arrives fasting to the outpatient infusion suite or endocrine clinic laboratory. Baseline vital signs and a baseline serum cortisol are obtained, followed by administration of synthetic adrenocorticotropic hormone (cosyntropin). Serum cortisol is drawn at specified intervals (commonly 30 and 60 minutes). Results are interpreted by the endocrinologist to determine whether cortisol response is adequate, informing diagnosis (primary vs secondary adrenal insufficiency), need for further testing (insulin tolerance test, morning cortisol/ACTH), and management (glucocorticoid replacement). Typical sites of service include outpatient clinic-based procedure rooms, hospital outpatient departments, and hospital inpatient floors when assessing acutely ill patients. The service is ordered and interpreted by an endocrinologist and may involve registered nurses or phlebotomists for medication administration and timed blood draws.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation portion is billed separately from the technical component. |