CPT code 84403: Testosterone, total hormone level2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures total testosterone in a blood specimen for evaluation of androgen deficiency or excess and monitoring of testosterone treatment.
Medicare pays $25.81 for 84403 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
$25.81
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 8 sections
What 84403 covers
This assay measures total testosterone, the combined amount circulating in the blood. Clinicians order it when evaluating possible androgen deficiency, such as symptoms of low testosterone in an adult man, or androgen excess, such as signs of excess androgen in a woman. It is also used in evaluations of abnormal pubertal development and to monitor testosterone treatment. The code identifies the total hormone measurement, not a free or bioavailable fraction.
Report this code for the total testosterone assay performed. A separately performed free or bioavailable testosterone assay is represented by its own code. Medicare pays this test only through the CLFS, at one national amount without geographic or office-versus-facility adjustment. The 2026 national CLFS amount is $25.81, unchanged since 2020. The test is excluded from the physician fee schedule.
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 84403
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 84403. 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 84403 with status X (excluded by statute), so the test itself is paid only from the CLFS.
84403 on the lab fee schedule since 2020
84403 · CLFS 2026 Q4 (current)
$25.81
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.
84403 compared with similar tests
- 84402Free testosteroneUnbound hormone fraction$25.47
- Choose 84403 for total testosterone; choose 84402 when the assay measures the free fraction.
- 84410TestosteroneBioavailable fraction$51.28
- 84403 measures total testosterone, while 84410 reports bioavailable testosterone.
- 84270SHBG assayBinding protein level$21.73
- 84270 measures sex hormone-binding globulin, not testosterone. It may be ordered alongside testosterone testing as part of an androgen evaluation.
84403 billing questions
When should total testosterone be reported instead of free testosterone?
Report this code for the total testosterone measurement. Use 84402 when the laboratory performs a free testosterone assay; the two codes identify different measurements.
How does this code differ from bioavailable testosterone?
This code reports total testosterone. Code 84410 identifies a bioavailable testosterone measurement, a different fraction of the hormone.
Does the total testosterone assay include a free testosterone result?
No. Report a free testosterone assay separately when it is performed, using 84402.
Is there a physician-fee-schedule payment for this test?
No. Medicare pays the test only through the CLFS, using one national amount across localities and care settings.
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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