Summary & Overview

CPT 80426: Serial FSH and LH Quantitative Assay, Four Timed Samples

Headline: CPT code 80426: Serial FSH and LH Quantitative Assay Using Four Timed Serum Samples

Lead: CPT code 80426 captures a specialized laboratory service measuring follicle stimulating hormone (FSH) and luteinizing hormone (LH) across four timed serum samples. The code is used for dynamic endocrine evaluation and has implications for reproductive diagnostics and lab billing practices nationwide.

CPT code 80426 represents a serial quantitative hormone assay that measures FSH and LH levels on four separate serum specimens obtained at scheduled intervals during a single procedure. This test is clinically relevant for assessing pituitary-gonadal axis function, ovulatory status, and other reproductive-endocrine conditions. Nationally, accurate coding and documentation matter for appropriate laboratory reimbursement and for consistent clinical interpretation across settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding intent and clinical context, typical sites of service, common modifiers associated with laboratory services, and what is known about payer coverage patterns. The publication provides benchmarks where available, notes on documentation expectations, and a concise review of clinical scenarios that commonly drive use of this code.

This summary is intended to inform billing professionals, laboratory directors, and clinicians about the purpose of CPT code 80426 and the operational considerations tied to delivering and billing for a four-sample FSH/LH assay.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 80426hormone assayFSHLHclinical laboratoryreproductive endocrinologyserial samplinglaboratory billingtimed serum test

Billing Code Overview

CPT code 80426 describes a laboratory procedure in which a lab analyst measures the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH) across a series of four serum samples collected at four different times during a single procedure.

Service Type: Serial quantitative hormone assay

Typical Site of Service: Clinical laboratory or hospital outpatient laboratory

This service involves timed serial blood draws and laboratory analysis to assess dynamic patterns of FSH and LH secretion for clinical evaluation of reproductive endocrine function. Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a reproductive-age woman undergoing evaluation for suspected ovulatory dysfunction or infertility. The clinician orders a timed serum gonadotropin panel to obtain follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels measured from four blood draws collected at specified intervals (for example baseline and three subsequent time points) to evaluate pulsatility, surge pattern, or dynamic responses during an ovarian stimulation cycle or evaluation of hypothalamic-pituitary-ovarian axis function. The workflow: the patient presents to an outpatient phlebotomy clinic or fertility clinic on a scheduled procedure day; nursing places an intravenous or uses serial venipuncture to collect four serum samples at the prescribed time points; each sample is labeled and sent to the laboratory; the lab analyst performs immunoassays for FSH and LH on all four specimens and reports values to the ordering clinician, who interprets patterns in the context of menstrual history, medications, and other endocrine testing.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician professional interpretation component separate from the laboratory technical component (if applicable in mixed-service settings).
`59`	Distinct procedural service	Use when this timed hormone panel is distinctly separate from another procedure or test performed the same day not normally billed together.
`52`	Reduced services	Use when the laboratory or clinic performs a reduced version of the full timed series (e.g., fewer draws) and payment should be reduced accordingly.
`53`	Discontinued procedure	Use if the timed collection series is started but terminated early for patient safety or clinical reasons.
`90`	Reference (outside) laboratory	Use when the specimen testing is performed by an outside/reference laboratory and not by the billing laboratory.
`TC`	Technical component	Use when billing only the laboratory technical component (assay performance, equipment, supplies) and the professional interpretation is not billed by the same entity.
`QX`	Certified registered nurse anesthetist (CRNA) service – under personal supervision of anesthesiologist	Included because CRNAs appear in modifier lists for facility billing contexts; use only when applicable to the provider performing billable services under supervision.
`QY`	Medical direction by a physician of one CRNA	Use in specific anesthesia staffing scenarios when applicable to the session in which timed draws occur in operative settings.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services in assistant at surgery	Use only if an advanced practice clinician is billing as assistant in an associated surgical procedure on the same date.
`22`	Increased procedural services	Use when the procedure requires substantially greater resources or time (rare for a standardized timed hormone series) and appropriate documentation supports additional payment.
`90`	Reference (outside) laboratory	Duplicate entry avoided; see previous `90`.

Taxonomy Code	Specialty	Notes
136F00000X	Reproductive Endocrinology	Specialists managing infertility and endocrine evaluation who commonly order timed gonadotropin panels.
207Q00000X	Obstetrics & Gynecology	General OB/GYNs evaluating menstrual disorders, subfertility, and ovarian function.
310400000X	Clinical Laboratory	Laboratories and pathologists performing hormone immunoassays and reporting results.
367500000X	Family Medicine	Primary care clinicians who may initiate endocrine evaluation in women with menstrual irregularities.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N97.0`	Female infertility associated with anovulation	Anovulation is a primary indication for timed FSH/LH series to assess ovulatory axis function.
`N91.2`	Oligomenorrhea	Infrequent menses prompts endocrine workup including gonadotropin measurement.
`E28.2`	Polycystic ovarian syndrome	PCOS commonly requires gonadotropin assessment; FSH and LH patterns help differentiate PCOS from other etiologies.
`E23.0`	Hypopituitarism	Pituitary disorders affect FSH/LH secretion; timed series can assist in evaluation.
`E28.9`	Ovarian dysfunction, unspecified	General reason to measure serial gonadotropins when ovarian dysfunction is suspected.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`83001`	Qualitative pregnancy test (e.g., serum, urine)	Often performed before timed hormone panels to confirm nonpregnancy prior to ovarian stimulation or dynamic testing.
`84443`	Thyroid stimulating hormone (TSH)	Frequently ordered in evaluation of menstrual irregularity and infertility as part of endocrine assessment alongside FSH/LH testing.
`85025`	Blood count; complete (CBC) automated	Routine baseline laboratory screening performed in fertility workups or prior to procedures that may accompany timed sampling.
`83615`	Estradiol; direct (e.g., serum)	Commonly measured concurrently with FSH and LH to evaluate follicular development and ovarian response.
`86152`	Follicle stimulating hormone (FSH)	Individual FSH assay code used when single-point measurements are billed separately; related conceptually to the multi-sample panel represented by `80426`.
`83655`	Luteinizing hormone (LH)	Individual LH assay code used when single-point measurements are billed separately; related to the multi-sample series in `80426`.