Cortisol, Total [367X]

Test Code

22621

CPT Codes
82533

Preferred Specimen

1 mL serum

Minimum Volume

0.5 mL

Instructions

Note: Assay not recommended when patient is receiving prednisone/prednisolone therapy due to cross reactivity with the antibody used in this assay.

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 7 days
Refrigerated: 7 days
Frozen: 28 days

Methodology
Immunoassay (IA)

Setup Schedule

Set up: Mon-Sat; Report available: 36-48 hours

Reference Range

0-3 Days (infants)
Premature (31-35 Weeks)	a.m. or p.m. ≤15.0 mcg/dL
Term	a.m. or p.m. ≤14.0 mcg/dL
4 Days-1 Month	a.m. or p.m. Not established
2-11 Months	a.m. 3.0-23.0 mcg/dL p.m. Not established
1-17 Years	a.m. 3.0-25.0 mcg/dL p.m. 3.0-17.0 mcg/dL
Adult 8 a.m. (7-9 a.m.) specimen	4.0-22.0 mcg/dL
Adult 4 p.m. (3-5 p.m.) specimen	3.0-17.0 mcg/dL

Clinical Significance

Cortisol is increased in Cushing's Disease and decreased in Addison's Disease (adrenal insufficiency). Emerging data has demonstrated that patients with difficult-to-treat Type II Diabetes (HbA1c >7.5% despite medication) may also have elevated cortisol levels, akin to Cushing's Disease; however, the physical manifestations are not as obvious, and prevalence is significantly higher.

1. Buse JB, Kahn SE, Aroda VR, et al. Prevalence of hypercortisolism in difficult-to-control type 2 diabetes. Diabetes Care. 2025;48(12):2012-2020 doi: 10.2337/dc24-2841
2. DeFronzo RA, Auchus RJ. Cushing Syndrome, hypercortisolism, and glucose homeostasis: a review. Diabetes. 2025;74(12):2168-2178. doi: 10.2337/db25-0120
3. Lundqvist MH, Pereira MJ, Almby K, et al. Regulation of the cortisol axis, glucagon, and growth hormone by glucose is altered in prediabetes and type 2 diabetes. J Clin Endocrinol Metab. 2024;109:e675-e688. doi: 10.1210/clinem/dgad549
4. Nieman LK, Biller BMK, Findling JW, et al. The diagnosis of Cushing's Syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008; 93: 1526-1540. doi: 10.1210/jc.2008-0125
5. DeFronzo RA, Fonseca V, Aroda VR, et al. Inadequately controlled type 2 diabetes and hypercortisolism: improved glycemia with mifepristone treatment. Diabetes Care. 2025;48(12):2036-2044. doi: 10.2337/dc25-1055

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.