Summary & Overview
CPT 83497: 5-Hydroxyindolacetic Acid (5-HIAA) Urine Assay
CPT code 83497 describes a quantitative laboratory assay for 5-hydroxyindolacetic acid (5-HIAA) in a 24-hour urine specimen, used primarily to identify or monitor carcinoid tumors and carcinoid syndrome. As a specialized biochemical test, this code reflects diagnostic evaluation in oncology and endocrinology and is relevant to clinicians, laboratory managers, and payers assessing coverage and utilization of neuroendocrine tumor diagnostics.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement practices for this test influence access to diagnostic evaluation for suspected neuroendocrine tumors and affect laboratory billing workflows.
Readers will find context on the clinical purpose of the test, typical settings where it is performed, and the role CPT code 83497 plays in claims and billing. The publication provides national benchmarking and policy-relevant discussion points, including payer coverage patterns, utilization benchmarks, and coding considerations for laboratories and clinicians. Data not available in the input is noted where specific payer rates, regional variations, or associated ICD-10 diagnoses would otherwise be presented.
Billing Code Overview
CPT code 83497 measures the amount of 5-hydroxyindolacetic acid (5-HIAA), typically performed on a 24-hour urine specimen. This laboratory test is used by clinicians primarily for the determination of carcinoid tumors or carcinoid syndrome, assisting in diagnosis and monitoring of patients with suspected or confirmed neuroendocrine tumors.
Service Type: Clinical laboratory test — quantitative biochemical assay
Typical Site of Service: Clinical laboratory or hospital outpatient laboratory using a 24-hour urine collection
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with episodic flushing, chronic diarrhea, and abdominal cramping. The clinician suspects a carcinoid tumor or carcinoid syndrome based on symptoms and an elevated chromogranin A. The clinician orders a 24-hour urine collection for measurement of 5-hydroxyindoleacetic acid to quantify serotonin metabolite excretion.
Urine is collected over 24 hours in a preservative-containing container, stored appropriately, and delivered to the clinical laboratory. The lab analyst performs specimen accessioning, measures total volume, aliquots as needed, and runs the assay (commonly HPLC or mass spectrometry). Results are reported to the ordering clinician, who uses the value to support diagnosis, monitor disease activity, or evaluate response to therapy. Typical site of service is an outpatient laboratory or hospital clinical laboratory. The service type is a diagnostic biochemical assay of a 24-hour urine specimen.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the professional interpretation/report component is billed separately from technical work |
TC | Technical component |