CPT code 84138: Pregnanetriol, urinary steroid metabolite2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Urinary pregnanetriol measurement assesses steroid metabolism, particularly during evaluation of congenital adrenal hyperplasia and adrenal steroid production.
Medicare pays $21.05 for 84138 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$21.05
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 7 sections
What 84138 covers
This assay measures pregnanetriol, a urinary metabolite of steroid hormones. Endocrinologists and other clinicians may order it when assessing adrenal steroid production, including evaluation of congenital adrenal hyperplasia. A clinical laboratory performs the measurement on a urine specimen; the result is interpreted alongside the patient’s clinical findings and other relevant hormone tests.
Report 84138 for the pregnanetriol assay, not for measurement of a different steroid such as pregnanediol or progesterone. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $21.05, unchanged since 2020; one amount applies nationwide, without locality or office-versus-facility adjustment. The code is excluded from the physician fee schedule by statute, so there is no separate physician-fee-schedule payment.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 84138
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 84138. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 84138 with status X (excluded by statute), so the test itself is paid only from the CLFS.
84138 on the lab fee schedule since 2020
84138 · CLFS 2026 Q4 (current)
$21.05
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
84138 compared with similar tests
- 84135PregnanediolReproductive hormone level$21.27
- Choose 84135 for pregnanediol; 84138 is for pregnanetriol. These are distinct analytes, not interchangeable assay names.
- 84140PregnenoloneReproductive hormone assay$20.67
- 84140 measures pregnenolone. Use 84138 when the requested analyte is pregnanetriol.
- 84144Progesterone testSerum concentration$20.86
- 84144 measures progesterone itself, whereas 84138 measures pregnanetriol, a steroid metabolite.
84138 billing questions
When should 84138 be chosen instead of 84135?
Use 84138 for measurement of pregnanetriol. Code 84135 measures pregnanediol, a different steroid metabolite.
What specimen is used for this assay?
The assay measures pregnanetriol in urine.
Is a physician interpretation billed separately?
Medicare pays 84138 through the CLFS; the code is excluded from the physician fee schedule by statute.
How does Medicare price 84138?
Medicare uses one national CLFS amount for the code across localities, with no office or facility difference.
Can 84138 be reported for a progesterone measurement?
No. It represents a pregnanetriol assay; progesterone measurement is reported with 84144.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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