Summary & Overview
CPT 84135: Pregnanediol Quantitative Assay, Urine
CPT code 84135 identifies a laboratory assay that quantifies pregnanediol, a progesterone metabolite, in a patient specimen (commonly urine). This biochemical test supports evaluation of luteal phase adequacy, pregnancy monitoring, and certain fertility or endocrine assessments. Nationally, accurate coding of this laboratory service affects claims processing, clinical reporting, and laboratory utilization metrics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical purpose of the assay, common settings where the service is performed, and payer coverage considerations. The publication outlines benchmarks for utilization and reimbursement trends where available, summarizes relevant policy updates affecting laboratory billing, and clarifies typical service locations and clinical indications tied to this assay.
This report is intended for billing managers, laboratory directors, and policy analysts seeking a concise reference on the clinical role and billing context of CPT code 84135. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 84135 describes a laboratory assay performed by a lab analyst to evaluate the level of pregnanediol in a patient specimen, such as urine. This test measures a progesterone metabolite and is used in clinical contexts that assess luteal function, pregnancy monitoring, or hormonal evaluation.
Service type: Laboratory test — quantitative analysis of pregnanediol
Typical site of service: Clinical laboratory or outpatient laboratory collection site
Clinical & Coding Specifications
Clinical Context
A reproductive endocrinologist or obstetrics/gynecology clinic orders a measurement of pregnanediol in a urine specimen to evaluate luteal phase progesterone production or to monitor corpus luteum function in a patient undergoing fertility evaluation or treatment. Typical patients include women with suspected luteal phase deficiency, infertility undergoing timed intercourse or intrauterine insemination cycles, or patients monitored after ovulation induction. The clinical workflow: the provider documents the indication and orders CPT 84135. The patient collects a timed urine specimen (often a 24-hour or first-morning specimen depending on local protocol) and returns it to the outpatient laboratory or central lab. The medical technologist or lab analyst performs the quantitative assay for pregnanediol, records results in the laboratory information system, and reports values to the ordering clinician. The clinician interprets the result in context of cycle timing, serum progesterone if available, and treatment plan. Typical site of service is an outpatient laboratory or clinic-based lab; testing may also be performed in a hospital reference laboratory when required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |