Testosterone, Total (CPT 84403)
Medicare Rate vs. Lab Charges
Medicare pays $25.10 for this test. Labs commonly charge $89.00–$350.00. That's a 255%–1294% markup above what Medicare pays.
What This Test Is
This test measures total testosterone in blood. It's ordered for men with fatigue, low libido, or erectile dysfunction; for women with irregular periods or ovarian concerns; and to monitor hormone replacement therapy. Testosterone levels vary by time of day and sex.
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $25.10 |
| Typical Lab Charge Range | $89.00–$350.00 |
| Average Markup Above Medicare | 255%–1294% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers testosterone testing when ordered by a physician for documented symptoms or hormone-related concerns.
Common Reasons for Denial
- Ordered without clinical symptoms or documented indication
- Screening in asymptomatic patient
- Testing to monitor testosterone replacement in healthy individual without medical record
- Duplicate test without symptom change or therapy adjustment
- Ordered for bodybuilding or athletic performance assessment
What To Do If You're Overcharged
If you received a lab bill that seems unusually high compared to Medicare rates:
- Check your Explanation of Benefits (EOB) from Medicare or your insurance to see what should have been paid.
- Request an itemized bill from the lab showing all charges.
- Compare to GougeStop rates for your area to see if the charge is reasonable.
- Contact the lab's billing department to dispute erroneous charges or negotiate a lower rate.
- File an appeal with Medicare if a claim was incorrectly denied.
Frequently Asked Questions
A: Early morning (before 10am) is best, since testosterone levels peak in the morning and decline throughout the day. Your doctor should specify this.
A: Yes, if you have documented symptoms (fatigue, low libido, muscle loss) and a treating physician. Routine screening in healthy men is less likely to be covered.
A: Urban teaching hospitals and specialized clinics charge more. Independent labs and rural facilities often charge less. Location and facility type matter.