Summary & Overview
CPT 83498: 17-Hydroxyprogesterone Quantitative Assay
CPT code 83498 denotes a laboratory assay that quantitatively measures 17-hydroxyprogesterone in specimens such as blood, serum, urine, or amniotic fluid. This steroid intermediate is central to adrenal steroidogenesis and its measurement has clinical importance for diagnosing and monitoring adrenal disorders, including congenital adrenal hyperplasia and other cortisol biosynthesis defects. Nationally, accurate coding and laboratory reporting for this test affect clinical decision-making, laboratory workflows, and payer coverage determinations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and the typical sites of service where the assay is performed, plus practical information on modifiers and billing considerations when available. The publication also summarizes common payer approaches and benchmarks where data exists, highlights relevant policy updates affecting laboratory testing and coverage, and outlines areas clinicians and billing staff should verify with individual payers. This summary is intended for laboratory managers, billing professionals, and clinicians seeking a concise reference on the clinical role and billing identity of CPT code 83498 at a national level.
Billing Code Overview
CPT code 83498 is a laboratory test that measures 17-hydroxyprogesterone in a biological sample such as blood, serum, urine, or amniotic fluid. The analyte is a steroid precursor produced by the adrenal cortex and is a building block for the hormone cortisol. Measurement of 17-hydroxyprogesterone is used in clinical settings to evaluate adrenal function, including detection and monitoring of conditions such as congenital adrenal hyperplasia and other disorders of steroidogenesis.
Service type: Laboratory testing — quantitative steroid assay
Typical site of service: Clinical laboratory, hospital laboratory, or reference laboratory
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Clinical & Coding Specifications
Clinical Context
A typical patient is a child or adolescent referred to endocrinology for evaluation of suspected congenital adrenal hyperplasia (CAH) or an adult with symptoms of adrenal insufficiency or virilization. The clinician orders measurement of 17-hydroxyprogesterone to assess steroidogenesis and determine whether 21-hydroxylase deficiency or other adrenal disorders are present. A blood (serum or plasma) sample is collected in the outpatient laboratory or inpatient phlebotomy area; in neonatal screening programs a heel-stick blood spot or a specimen sent from a birthing center may be used. The specimen is sent to the clinical chemistry or endocrinology laboratory where the lab analyst performs an immunoassay or mass spectrometry-based quantitative measurement of 17-hydroxyprogesterone. Results are reported to the ordering provider, who integrates the value with clinical findings, electrolyte panels, and possibly cortisol and ACTH measurements to guide diagnosis, genetic testing, or treatment adjustments. Typical sites of service include outpatient physician offices, hospital outpatient labs, inpatient hospital laboratories, and newborn screening facilities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional interpretation component is billed by the physician/lab director |
TC |