Thyroid Stimulating Hormone (TSH) (CPT 84443)
Medicare Rate vs. Lab Charges
Medicare pays $16.80 for this test. Labs commonly charge $60.00–$220.00. That's a 257%–1210% markup above what Medicare pays.
What This Test Is
TSH is the primary screening test for thyroid function. Elevated or low TSH can indicate hyperthyroidism or hypothyroidism. Doctors order this when evaluating fatigue, weight changes, temperature sensitivity, or to monitor thyroid medication (levothyroxine).
Medicare Rate vs. Lab Charges
| Medicare Allowable Rate | $16.80 |
| Typical Lab Charge Range | $60.00–$220.00 |
| Average Markup Above Medicare | 257%–1210% |
Does Medicare Cover This Test?
Yes, Medicare Part B covers TSH screening and monitoring. Initial screening is typically covered; ongoing monitoring is covered for patients on thyroid medication.
Common Reasons for Denial
- Ordered without symptoms or history of thyroid disease
- Tested too frequently (e.g., monthly) without medication changes
- Patient on stable thyroid replacement with recent TSH test
- Screening in asymptomatic patient without risk factors
- Duplicate test within short timeframe
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: After starting or changing dose, recheck in 6-8 weeks. Once stable, annual testing is typical. If symptoms persist, your doctor may test more frequently.
A: Yes, if clinically indicated. Often both TSH and Free T4 are ordered together to fully evaluate thyroid function.
A: TSH requires specialized equipment and reagents. Hospital labs and major chains often charge premium rates; independent labs may be cheaper.