Summary & Overview
CPT 80406: ACTH Stimulation Test for Adrenal Function
CPT code 80406 designates the ACTH stimulation test, a diagnostic procedure used by endocrinologists to evaluate adrenal gland function by measuring cortisol levels in response to synthetic adrenocorticotropic hormone. Nationally, this test is an important tool for diagnosing adrenal insufficiency, secondary adrenal disorders, and for assessing the hypothalamic-pituitary-adrenal axis in complex endocrine cases.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about when the ACTH stimulation test is used, typical sites of service such as hospital outpatient clinics, outpatient laboratories, and endocrinology clinics, and an overview of billing considerations relevant to payers. The publication summarizes standard use cases, common claim modifiers (input provided), and notes where input data is not available.
This resource is intended for billing managers, practice administrators, and clinicians who need a concise summary of the test’s clinical purpose and payer relevance. It highlights benchmark and policy topics typically addressed for procedural lab testing reimbursement and claims handling, while noting where specific payer policy details or diagnosis mapping were not provided in the input.
Billing Code Overview
CPT code 80406 represents an ACTH stimulation test, a diagnostic endocrine procedure used to assess adrenal gland function by measuring cortisol response after administration of synthetic adrenocorticotropic hormone (ACTH). This test is typically ordered and interpreted by endocrinologists to evaluate adrenal insufficiency and related disorders.
Service type: Diagnostic endocrine stimulation test
Typical site of service: Hospital outpatient clinic, outpatient laboratory, or endocrinology clinic
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 46-year-old female presents to an endocrine clinic with progressive fatigue, unintentional weight loss, orthostatic dizziness, and hyperpigmentation. The endocrinologist suspects primary adrenal insufficiency and orders an ACTH stimulation test to evaluate adrenal cortisol reserve. On the day of testing the patient arrives fasting; baseline serum cortisol and plasma ACTH are drawn. Synthetic cosyntropin is administered intravenously or intramuscularly, and cortisol levels are measured at baseline, 30, and 60 minutes. The endocrinologist interprets the cortisol response in the context of baseline ACTH, prior glucocorticoid use, and clinical signs to confirm primary versus secondary adrenal insufficiency and to guide treatment decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation/report is billed separately from the technical component. |
TC | Technical component | Use when only the technical component (e.g., specimen collection, lab processing) is billed. |