Summary & Overview
CPT 83835: Plasma Metanephrines Assay
CPT code 83835 represents a laboratory biochemical assay that measures metanephrines, the metabolic products of epinephrine, in patient specimens. Clinically, elevated metanephrine levels are an important biomarker for pheochromocytoma and adrenal tumors and have implications for the diagnosis of secondary causes of hypertension. Nationally, accurate laboratory coding for this test supports diagnostic workflows, care coordination, and claims processing for endocrinology and hypertension evaluations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary provides a national perspective on coding practice and payer coverage considerations without state-specific variation.
Readers will learn the clinical context for CPT code 83835, typical sites of service and service type, and what to expect in payer coverage terminology. The publication also summarizes common billing modifiers and related administrative considerations where available. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 83835 describes a laboratory test in which a clinical laboratory analyst measures the amount of metanephrines, metabolic products of epinephrine, in a patient specimen. Elevated metanephrine levels are associated with pheochromocytoma and other adrenal tumors and can be clinically relevant to the evaluation of unexplained or secondary hypertension.
Service type: Clinical laboratory biochemical assay
Typical site of service: Clinical laboratory or hospital laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents to an outpatient endocrinology clinic with episodic headaches, palpitations, diaphoresis, and labile hypertension. The provider suspects a catecholamine-secreting tumor (pheochromocytoma or paraganglioma) and orders biochemical testing. A phlebotomy technician collects a plasma sample (or the patient provides a 24-hour urine specimen when indicated) under pretest preparation instructions (e.g., medication review, dietary restrictions) and sends it to the clinical laboratory. In the lab, a clinical laboratory analyst performs quantitative measurement of metanephrines using immunoassay or mass spectrometry. Results are reported to the ordering clinician; markedly elevated plasma free metanephrines or urine fractionated metanephrines prompt confirmatory imaging and referral to endocrinology or oncology for further management. Typical sites of service include hospital outpatient laboratory, independent clinical laboratory, and hospital inpatient laboratory when inpatient testing is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the interpretation or professional portion of a split technical/professional service (if applicable in lab interpretation contexts). |
TC |