Overview
CPT® code 84403 is used to report the laboratory measurement of total testosterone concentration in a patient’s serum or plasma. Testosterone, a key androgenic hormone, plays a vital role in regulating reproductive function, muscle mass, bone density, and overall metabolic health. Measuring total testosterone includes both the protein-bound and free fractions, providing a comprehensive picture of circulating hormone levels.
When to Use CPT 84403
Report 84403 when assessing testosterone-related disorders such as hypogonadism, infertility, erectile dysfunction, or abnormal hair growth. It is also used in the evaluation of polycystic ovary syndrome (PCOS) in women and in monitoring hormone replacement therapy in men.
Key Requirements
- A serum or plasma specimen is required.
- Documentation must include the clinical rationale for testing—such as symptoms of hormonal imbalance or endocrine dysfunction.
- Often ordered alongside free testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) for a full hormonal profile.
Billing Guidelines
- Use 84403 for total testosterone only.
- Do not report 84402 (Free Testosterone) for the same specimen unless the free fraction is tested separately.
- Ensure medical necessity is clearly documented to support reimbursement.
- Report once per encounter unless distinct, medically necessary repeat testing is performed.
Example Clinical Scenarios
- A male patient presents with low libido and fatigue—testing total testosterone helps confirm suspected hypogonadism.
- A female patient with irregular menses and hirsutism undergoes a hormone panel that includes total testosterone to assess androgen excess.
Summary
CPT® code 84403 is used for quantifying total testosterone in serum or plasma to evaluate hormonal balance, endocrine function, and reproductive health. This test is essential in diagnosing and managing both male and female hormone disorders.
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