Summary & Overview
CPT 84138: Pregnanetriol Measurement Assay
CPT code 84138 represents a clinical laboratory assay for measuring pregnanetriol concentrations in a patient specimen, typically urine. This biochemical test is used in the evaluation of steroid metabolism and can support the diagnosis and monitoring of endocrine disorders. As a discrete laboratory service, it is billed under CPT laboratory coding and is relevant for clinical labs, hospital laboratories, and outpatient specimen collection sites nationwide.
Key payers commonly included in coverage and analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on the code’s clinical role, typical sites of service, and the payer landscape. The publication provides benchmarks for service use and billing practice context, summarizes relevant policy and coverage considerations at a national level, and outlines clinical context for when the assay is ordered.
The report is intended for billing professionals, laboratory managers, and policy analysts seeking concise information on coding, clinical application, and payer considerations for CPT code 84138. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 84138 describes a laboratory test that measures pregnanetriol levels in a patient specimen, commonly urine. The procedure is a biochemical assay performed by a clinical laboratory analyst to evaluate metabolite levels related to steroid metabolism.
Service type: Clinical laboratory test — biochemical assay
Typical site of service: Clinical laboratory or hospital laboratory (ambulatory specimen collection such as outpatient phlebotomy or urine collection)
Clinical & Coding Specifications
Clinical Context
A typical patient is a pediatric or adult patient referred for biochemical evaluation of adrenal or steroid metabolism disorders. A clinician suspects an inborn error of steroidogenesis, adrenal insufficiency, congenital adrenal hyperplasia variant, or an endocrine tumor producing steroid metabolites. The patient provides a timed or 24-hour urine specimen collected per laboratory instructions. The clinical workflow: the ordering provider (often pediatric endocrinology, adult endocrinology, or metabolic genetics) places an order for urinary pregnanetriol measurement (CPT 84138). The patient collects the urine at home or in clinic, returns the specimen to the laboratory with appropriate labeling and clinical information. The clinical laboratory accessioning team verifies patient information and specimen integrity, the lab analyst performs the assay to quantify pregnanetriol, documents results in the laboratory information system, and releases results to the ordering provider. Results are reviewed in context of cortisol, 17-hydroxyprogesterone, urinary steroid profile, and clinical presentation to guide diagnosis and management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component provided by a physician for the test result interpretation. |