CPT code 84144 – Progesterone quantitative assay

Key takeaways

CPT code 84144 covers a quantitative serum or plasma progesterone test, not 17-hydroxyprogesterone or tissue receptor assays.

Medicare pays 84144 at one national CLFS rate of $20.86 in 2026, with no locality adjustment.

A diagnosis code that doesn’t match the documented reason for the test is the most common denial trigger.

When a reference lab runs the test for a Medicare patient, the lab bills 84144 and the practice bills only the draw.

Fertility indications often need prior authorization, and Medicare may deny ART monitoring labs as non-covered.

CPT code 84144 measures one hormone, one way

CPT code 84144 is the AMA-maintained code for a quantitative progesterone assay on serum or plasma. It sits in the Chemistry subsection (82009-84999) of the Pathology and Laboratory section (80047-89398). Because it’s a lab code, Medicare pays it under the Clinical Laboratory Fee Schedule (CLFS) rather than the Physician Fee Schedule.

The official descriptor is a single word: Progesterone. The code doesn’t name a method, so chemiluminescent and electrochemiluminescent immunoassays bill the same way.

The quick-reference table below holds the details you’ll reach for at claim time.

Look-alike hormone codes are the fastest way to miscode 84144

A one-word descriptor makes wrong-code errors easy. So before 84144 goes on the claim, rule out its neighbors.

• Covered: Quantitative serum or plasma progesterone by immunoassay. Typical reasons include luteal phase checks, assisted reproductive technology (ART) monitoring, threatened miscarriage workups and supplementation monitoring.
• Not 84144: Urine or salivary progesterone assays, and progesterone receptor testing on tumor tissue. Receptor testing bills as CPT 88360, or 88361 when computer-assisted.
• Common miscodes: CPT 84146 (prolactin), 84702 (quantitative hCG), 83498 (17-hydroxyprogesterone) and 84999 (unlisted chemistry).

The 84144 and 84702 pair trips up fertility billing teams most often. Both are reproductive hormone tests, and they’re often drawn at the same visit. When both are ordered, each bills on its own line after an NCCI edit check for that date.

Medical necessity for 84144 starts with the reason on the order

A progesterone claim gets paid when the chart shows why the test was needed. So the ordering provider’s note should name one of these indications before the claim leaves:

• Luteal phase assessment to confirm ovulation when anovulation is suspected
• Ovulation confirmation, typically drawn on cycle day 21 of a 28-day cycle
• ART monitoring during IVF or IUI protocols, tracking the progesterone rise after trigger
• Threatened miscarriage workups, to judge whether progesterone support is adequate
• Ectopic pregnancy monitoring within serial hCG-plus-progesterone protocols
• Monitoring of patients on progesterone therapy
• Corpus luteum function checks during irregular cycle investigations

Payers draw the prior authorization line in different places, though. Private plans often want pre-authorization for ART and infertility workups. Routine cycle monitoring usually clears without it, as long as the ICD-10 code matches a covered indication.

The ICD-10 code has to match why progesterone was drawn

A diagnosis the payer won’t accept for this test is the most common 84144 denial trigger. The code should reflect the reason for the test, not the patient’s broader history. Pick the most specific code the note supports.

Check the applicable ICD-10-CM codes against your MAC’s local coverage determinations (LCDs) and billing articles before you bill. That matters most for the N97 and Z31 families, where coverage for progesterone testing varies. And if your EHR pre-fills a diagnosis on lab orders, confirm it matches the reason in the visit note.

Medicare pays one national rate for CPT code 84144 in 2026

Medicare pays $20.86 for 84144 in 2026, according to the CMS Clinical Laboratory Fee Schedule (CLFS). Since 2018, the Protecting Access to Medicare Act (PAMA) has set one national rate per lab code, based on private-payer data. That means there’s no locality or MAC adjustment to apply.

Medicare patients also owe no deductible or coinsurance on clinical lab tests, so don’t collect a copay for 84144. Commercial plans pay whatever your contract says, so check the contract rather than assume the Medicare figure.

Fertility indications are where 84144 coverage gets tight

Medicare covers 84144 when the note documents a covered indication and the claim carries a matching ICD-10 code.

Your MAC’s policies decide which indications qualify. Fertility work carries the most risk. Because ART itself is typically excluded, many MACs treat ART monitoring labs as non-covered too.

• ABN: When Medicare coverage for an indication is in doubt, have the patient sign an Advance Beneficiary Notice (ABN) before the draw. Without one, the practice carries the loss if Medicare denies.
• Commercial plans (Aetna, UHC, BCBS): Policies differ by plan. Fertility indications often need prior authorization, while routine hormone monitoring usually doesn’t. Verify with each payer rather than assume coverage.
• Medicaid: State programs vary widely. Some cover progesterone testing only for obstetric reasons, while others extend to fertility workups. Check your state’s Medicaid fee schedule separately.

Build these checks into lab ordering, so coverage problems surface before the draw instead of after the denial.

Here’s how a CPT 84144 claim moves from blood draw to payment

Most 84144 claims follow the same five steps. The decision that changes the claim most is who performs the test, so settle that first.

The flow below shows where each step tends to break.

1. Draw the specimen. Collect serum (red- or gold-top tube) or plasma, per the performing lab’s requirements. Bill the venipuncture as CPT 36415, which the 2026 CLFS pays at $9.34.
2. Decide who bills the test. If your in-house lab runs it, bill 84144 with POS 11 and your CLIA number in item 23. If a reference lab runs it for a Medicare patient, the lab bills 84144 directly and you bill only 36415.
3. Check for a purchased-test arrangement. Some commercial payers let the practice bill a test it bought from an outside lab. In that case, add modifier 90 to 84144. An independent lab billing its own work uses POS 81.
4. Add modifier 91 only for clinical repeats. Use it when a same-day repeat is medically necessary, such as serial ART monitoring. A rerun after a failed specimen doesn’t qualify.
5. Complete the CMS-1500. Put ICD-10 codes in item 21, point to them in 24E and add the rendering NPI in 24J. Then track the claim until the remittance posts.

Reference lab billing is where practices take the most compliance risk. If the lab already billed 84144, your claim for the same test is a duplicate. So write a simple rule down. When a reference lab runs the assay, the practice bills the draw and stops there.

Five denials keep coming back on 84144 claims, and each has a fix

Denials on 84144 are predictable, and the same few reasons repeat across billing cycles. Denial-tracking claims software shows which ones are systemic and which are one-offs.

• Non-covered ICD-10 pairing. The diagnosis isn’t on the payer’s covered list, or it doesn’t match the chart. Appeal with the visit note showing the indication, plus a letter of medical necessity from the ordering provider.
• Frequency limit exceeded. Some payers cap progesterone tests per cycle or per period. Appeal with the clinical reason for extra testing, such as an ART protocol that needs serial levels.
• Missing or invalid ABN. Medicare denied a test with uncertain coverage, and no ABN was signed. The practice absorbs the charge, because an ABN can’t be signed after the fact.
• Duplicate with the reference lab. The practice billed 84144 after the lab already had. Void your duplicate claim and assign billing responsibility in writing.
• No prior authorization. A fertility indication was denied for lack of pre-authorization. Appeal with the auth number, or request a retroactive authorization with supporting notes.

Start each fix by sorting denials by claim adjustment reason code (CARC). Decoding denial codes quickly shows which problems start at the front desk, like a missing auth. It also flags the ones that start in the back office. Most 84144 denials start at the front end, which makes them preventable.

Documentation that holds up when an auditor pulls the chart

The chart has to make the medical necessity case without the claim form. An auditor should find the reason for the test without reading between the lines. Four elements do that work.

• Signed test order. It names the ordering provider’s NPI, the test (“progesterone, serum” or CPT 84144) and the indication. A lab requisition with the provider’s electronic signature qualifies.
• The reason in the progress note. The visit or phone note states why the level is being checked. “Rule out anovulation” beats “hormonal evaluation.” “Day 21 progesterone to confirm ovulation, irregular cycles” is better still.
• ART protocol details. For fertility monitoring, record the protocol phase, the cycle day and the expected progesterone range. That detail is what survives a Medicare audit.
• Prior results for repeats. When a test repeats with modifier 91, the chart shows the earlier result and why the repeat was needed.

Linking each lab order to its encounter note in the EHR keeps that record together. Practices running labs off paper requisitions, with no rationale on file, carry more audit exposure.

Run this six-point check before any 84144 claim goes out

Most of the denials above can be caught in the minute before submission. Run each claim through these checks:

• The order names a specific reason, and the note matches it.
• The ICD-10 code in item 21 matches that reason, not the broader history.
• Fertility claims carry a prior auth number, and uncertain Medicare claims have a signed ABN.
• Only one party bills 84144, and a reference-lab draw bills as 36415 alone.
• Modifier 91 appears only on a clinically necessary same-day repeat.
• In-house tests carry your CLIA number in item 23.

Fertility panels bill 84144 next to four other hormone codes

Reproductive endocrinology practices rarely order 84144 alone. Progesterone usually sits inside a hormone workup, with each analyte billed on the same date. Knowing which codes pair, and which edits apply, prevents both undercoding and accidental unbundling.

A standard fertility workup includes the codes below. According to the AAPC’s CPT code set reference, each code here describes a single analyte and bills per analyte when performed.

Check NCCI edits before billing any combination on one date. Most fertility hormone codes in the 82000-84999 range have no edits against each other, so each bills when independently indicated.

Some payers add their own bundling rules on top, so confirm by payer. When lab codes run alongside IVF CPT codes, keep each component on its own line to avoid bundling flags.

How Pabau keeps progesterone claims clean from order to payment

Nearly every fix in this guide happens before a claim exists. The reason for the test, the diagnosis and the performing lab all have to be on record at order time.

Pabau keeps those details on the patient record, and the claim form pre-fills from it. The CPT code attached to the service lands on the charge line. ICD-10 slots are seeded from the patient’s recorded problem list, with full CPT and ICD-10-CM libraries to search.

Before a claim can go, Pabau checks that required fields, like membership numbers and authorization codes, are complete. US claims then go out through Claim.MD, with eligibility checks, claim-status tracking and remittance posting. So your team stops retyping codes from the chart and chasing payers by phone.

Send progesterone claims that pay the first time

Pabau pre-fills lab claims from the patient record, checks required fields before submission and sends US claims through Claim.MD. You spend less time reworking 84144 denials.

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Conclusion

At $20.86, a progesterone test rarely justifies an appeal. So 84144 is a code you want paid on the first pass, and that effort belongs at the order.

Start with fertility work. It holds the prior auth rules, the Medicare exclusions and the same-day repeats, so one clear protocol there covers your riskiest claims. Then agree, in writing, who bills when a reference lab runs the assay.

Settle those two decisions and 84144 becomes one of the quieter lines on your remittance. Book a demo to see how Pabau carries order details straight onto a clean progesterone claim.

Continue your research

Billing hCG on the same draw? CPT code 84702 covers the quantitative hCG test that so often pairs with progesterone.

Billing only the draw for a reference lab? CPT code 36415 explains venipuncture billing when an outside lab runs the test.

Need to verify IVF-related CPT codes alongside 84144? IVF CPT codes covers the full ART procedure billing set for fertility practices.

Managing denials across your lab billing? Denial codes in medical billing explains CARC and RARC codes and how to resolve claim denials systematically.

Looking for a clearinghouse integration for lab claims? Medical claims clearinghouse guide explains how clearinghouses process lab claims and what to look for in an integration.

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