TSH Blood Test (Thyroid Stimulating Hormone)
CPT 84443 is the primary thyroid screening test, measuring Thyroid Stimulating Hormone (TSH) levels. Medicare pays $16.44 for this test under the Clinical Laboratory Fee Schedule, but providers charge an average of $92.50 (a 5.6x markup). TSH alone is usually sufficient for initial screening, yet many providers reflexively order a full thyroid panel that adds $20 to $40 in unnecessary lab costs. Direct-to-consumer labs offer TSH tests for $25 to $50.
CPT 84443 at a Glance
- Medicare CLFS rate: $16.44
- Average provider charge: $92.50
- Markup: 5.6x over Medicare rate
- Direct-to-consumer price: $25 to $50
- Beneficiaries (2023): 9.1 million
- Fee schedule: Clinical Laboratory (CLFS)
- Rate type: National (no geographic adjustment)
- Related codes: 84439 (free T4), 84481 (free T3)
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How Lab Pricing Works (Clinical Laboratory Fee Schedule)
Unlike physician services that use RVUs and geographic adjustments, lab tests are priced under the Medicare Clinical Laboratory Fee Schedule (CLFS). The CLFS sets a single national rate for each lab test. There are no RVU components and no geographic cost adjustments. The same TSH test costs Medicare $16.44 whether drawn in San Francisco or rural Kentucky.
| Metric | Value |
|---|---|
| Medicare CLFS Rate | $16.44 |
| Average Provider Charge | $92.50 |
| Markup Ratio | 5.6x |
| Pricing Method | National rate (CLFS), no geographic variation |
Lab tests are priced under the Clinical Laboratory Fee Schedule, not the Physician Fee Schedule. Medicare lab rates are set nationally and do not vary by geographic location.
What Does a TSH Test Measure?
Thyroid Stimulating Hormone (TSH) is produced by the pituitary gland and controls how much thyroid hormone your thyroid makes. A TSH blood test is the primary screening test for thyroid disorders:
High TSH
- Suggests hypothyroidism (underactive thyroid)
- Pituitary is producing more TSH to stimulate the thyroid
- Symptoms: fatigue, weight gain, cold sensitivity
- Most common thyroid disorder
Low TSH
- Suggests hyperthyroidism (overactive thyroid)
- Pituitary is producing less TSH because thyroid is overactive
- Symptoms: weight loss, rapid heartbeat, anxiety
- Less common but can be serious
Normal TSH range is typically 0.4 to 4.0 mIU/L, though this varies slightly by lab and by age. TSH is the single most useful test for evaluating thyroid function, and it alone is usually sufficient for initial screening.
Do You Need a Full Thyroid Panel? Probably Not.
TSH is often ordered alongside free T4 (CPT 84439, $8.82) and free T3 (CPT 84481) as a "thyroid panel." But if TSH is normal, the T4 and T3 results are almost always normal too. Ordering the full panel reflexively adds $20 to $40 in lab costs with no clinical benefit for most patients.
| Test | When It Is Needed | Medicare CLFS |
|---|---|---|
| TSH (84443) | Initial screening, routine monitoring | $16.44 |
| Free T4 (84439) | Only if TSH is abnormal | $8.82 |
| Free T3 (84481) | Only if hyperthyroidism suspected | varies |
Where to Get a TSH Test for Less
You do not have to use your hospital's lab. Lab pricing varies dramatically depending on where you go. Here are your options, ranked from cheapest to most expensive:
Direct-to-Consumer Labs: $25 to $50
Services like Quest Diagnostics (walk-in), LabCorp patient service centers, Ulta Lab Tests, and Jason Health allow you to order a TSH test without a doctor's order in most states. You pay upfront, get your blood drawn at a local lab, and receive results online. Prices range from $25 to $50 for a TSH test.
Independent Labs (with doctor's order): $15 to $40
If your doctor sends you for lab work, ask for the order to be sent to an independent lab (Quest or LabCorp) rather than the hospital's in-house lab. Independent labs typically charge 50% to 80% less than hospital outpatient labs for the same test.
Hospital Outpatient Labs: $70 to $150+
Hospital labs are the most expensive option. They often add facility fees on top of the test cost. A TSH at a hospital lab can cost $70 to $150 or more. If your doctor is part of a hospital system, the lab order may automatically route to the hospital lab. Ask if you can use an independent lab instead.
What Insured Patients Actually Pay for a TSH Test
What you owe depends on your insurance plan. Important: TSH screening is NOT a USPSTF-recommended preventive service, so it is not guaranteed free under the ACA, even when ordered during a wellness visit.
| Your Situation | What You Likely Pay | How It Works |
|---|---|---|
| Copay plan (deductible met or N/A) | $0 to $10 | Many plans cover lab work at 100% after deductible |
| Coinsurance plan (deductible met) | $1 to $5 | 20% of negotiated rate ($5 to $25) |
| High-deductible plan (deductible NOT met) | $10 to $50 | Full negotiated rate applied to your deductible |
| Medicare Part B | $0 | Medicare covers clinical lab tests at 100% (no coinsurance) |
| ACA preventive wellness visit | May not be $0 | TSH is not USPSTF-recommended, not guaranteed free |
Related Thyroid Lab Codes
| Code | Description | Medicare CLFS |
|---|---|---|
| 84443 | TSH (Thyroid Stimulating Hormone) | $16.44 |
| 84439 | Free T4 (Thyroxine, free) | $8.82 |
| 84481 | Free T3 (Triiodothyronine, free) | varies |
Frequently Asked Questions
How much does a TSH test cost without insurance?
Without insurance, a TSH test (CPT 84443) costs $50 to $150 at most hospitals and clinics, with the national average charge at $92.50. Direct-to-consumer labs offer TSH tests for $25 to $50 without a doctor's order. Medicare pays $16.44 for this test.
Is a TSH test free under preventive care?
TSH screening is NOT a USPSTF-recommended preventive service, so it is not guaranteed free under the ACA. Even if ordered during a wellness visit, it may be subject to cost-sharing. Some insurance plans cover it voluntarily, but they are not required to. Check with your insurer before assuming it will be free.
Do I need free T4 and free T3 tests along with TSH?
In most cases, TSH alone is sufficient for initial thyroid screening. Free T4 (CPT 84439, $8.82) and free T3 (CPT 84481) are typically only necessary if TSH is abnormal. Some providers order the full thyroid panel reflexively, adding $20 to $40 in unnecessary lab costs. Ask your doctor if TSH alone is sufficient for your situation.
How often should you get a TSH test?
For people on thyroid medication, TSH is typically checked every 6 to 12 months once stable. For screening, there is no consensus on frequency. The American Thyroid Association suggests screening at age 35 and every 5 years after. Women, older adults, and people with family history of thyroid disease may benefit from more frequent testing.
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