Summary & Overview
CPT 84431: Urine Thromboxane Metabolites Measurement
CPT code 84431 identifies a urine assay for thromboxane metabolites, a laboratory test that measures biochemical markers of platelet activation. Nationally, this test supports clinical evaluation of thrombotic risk and monitoring of antiplatelet therapy effectiveness. It is performed in clinical and hospital outpatient laboratories and is relevant for specialists managing cardiovascular, hematologic, and inflammatory conditions.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical sites of service, and the clinical contexts in which the test is used. The publication presents benchmarks and coverage considerations across major national payers, highlights coding and billing practice points, and summarizes relevant clinical utility of the assay.
This summary is intended for billing managers, laboratory directors, and clinicians who need a national perspective on coding, site-of-service use, and payer coverage patterns for urine thromboxane metabolite testing. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 84431 describes a laboratory assay in which a lab analyst measures thromboxane metabolites, which may include thromboxane, in a patient's urine. The test evaluates biochemical markers related to platelet activation and eicosanoid metabolism and can inform clinical assessment of thrombotic risk or effectiveness of antiplatelet therapy.
Service type: Clinical laboratory diagnostic test
Typical site of service: Clinical laboratory or hospital outpatient laboratory
Clinical & Coding Specifications
Clinical Context
A 56-year-old male with a history of cardiovascular disease and persistent platelet activation is referred for biochemical assessment of prostanoid metabolism. The clinician orders a urinary thromboxane metabolite assay to evaluate in vivo platelet activation and to monitor response to antiplatelet therapy (for example, aspirin nonresponsiveness) or to investigate suspected prothrombotic states. A clean-catch urine specimen is collected in the outpatient laboratory or clinic, labeled, and transported to the clinical chemistry/mass spectrometry laboratory. The laboratory analyst performs the assay using appropriate analytical methods (for example, immunoassay or mass spectrometry) to quantify thromboxane metabolites in urine. Results are reviewed by the ordering provider to correlate with medication history, platelet function testing, and clinical risk factors for thrombosis. Typical site of service: hospital outpatient laboratory, independent clinical laboratory, or outpatient clinic lab.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation or analytical oversight by the pathologist/physician separate from the technical laboratory component |
TC |