Thyroid-Stimulating Hormone-Sensitive (s-TSH) with Reflex T4 (Thyroxine), Free and T3 (Triiodothyronine), Free, Plasma or Serum

Message

Testing Algorithm: Includes sensitive TSH with reflex testing to T4, free if the TSH is abnormal, and further reflexing to T3, free, if T4, free is normal or decreased. Reflexed tests will include an additional charge.

Test Code

1249

CPT Codes
84443-TSH; 84439-T4, free (if applicable); 84481-T3, free (if applicable)

Includes

T3 (Triiodothyronine), Free, Plasma or Serum
T4 (Thyroxine), Free, Plasma or Serum
Thyroid-Stimulating Hormone-Sensitive (s-TSH), Plasma or Serum

Preferred Specimen

Submit only 1 of the following specimens:

Plasma
Container/Tube: Green-top (heparin) tube(s)
Specimen Volume: 3 mL (minimum volume: 0.5 mL) of plasma
Note: 1. Indicate plasma. 2. Label specimen appropriately (plasma).

Serum
Container/Tube: Serum gel tube(s)
Specimen Volume: 3 mL (minimum volume: 0.5 mL) of serum
Note: 1. Indicate serum. 2. Label specimen appropriately (serum).

Minimum Volume

Pediatric volume: 1.5 mL

Transport Temperature

Refrigerate

Methodology
Immunoassay

Setup Schedule

Monday through Sunday

Reference Range

s-TSH
1-30 days: 0.520-16.000 µIU/mL
31 days-5 years: 0.460-8.100 µIU/mL
6 years-18 years: 0.360-6.000 µIU/mL
Adults: 0.358-3.740 µIU/mL

Clinical Significance

Useful for evaluating and monitoring thyroid function.

Performed By
CoxHealth

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.