Summary & Overview
CPT 84146: Prolactin Assay on Serum or Plasma
CPT code 84146 represents a laboratory assay for prolactin, a hormone most commonly measured to evaluate lactation-related conditions and select endocrine and reproductive disorders. As a routine clinical chemistry test performed on serum or plasma, this code affects laboratory billing workflows, payer coverage policies, and clinical diagnostic pathways nationwide. Its use is common across outpatient and hospital-based laboratories, making standardized coding and payment guidance important for laboratory administrators and billing teams.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, typical reimbursement considerations, and common billing practices associated with CPT code 84146. The publication also provides clinical context for when prolactin measurement is indicated and outlines operational implications for laboratory service lines.
This summary equips readers with benchmarking information, policy highlights, and practical coding context to support accurate submission and interpretation of CPT code 84146 for prolactin testing in clinical laboratory settings. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 84146 describes a laboratory prolactin assay. The service involves a clinical laboratory analyst performing the technical testing on blood specimens, typically serum or plasma, to measure prolactin, a hormone primarily involved in lactation and relevant in several endocrine and reproductive conditions.
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Service type: Clinical laboratory hormone assay
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 28-year-old woman presents to an outpatient women's health clinic with galactorrhea and secondary amenorrhea. The clinician obtains a serum specimen to measure prolactin to evaluate for hyperprolactinemia. The specimen is sent to the hospital clinical laboratory or a reference lab where a clinical laboratory scientist performs the immunoassay using automated instruments. Results are reviewed by the laboratory information system, validated by the analyst, and released to the ordering provider. Typical sites of service include hospital laboratories, independent clinical reference laboratories, and outpatient clinic laboratories. Common clinical workflow steps: order entry, specimen collection (serum or plasma), specimen accessioning, analysis on automated immunoassay analyzer, quality control checks, result validation, and reporting to the ordering clinician for endocrine or gynecologic management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional component of a lab service (interpretation by pathologist/physician) separate from technical testing. |
TC | Technical component | When billing only the technical component (laboratory instrument, technician labor, reagents) separate from professional interpretation. |