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An ACTH stimulation panel is a diagnostic test designed to evaluate the function of the adrenal glands, which are critical components of the endocrine system located above each kidney. This panel specifically assesses adrenal insufficiency, which can be categorized as either primary or secondary. Primary adrenal insufficiency may arise from conditions such as autoimmune adrenalitis, Addison's disease, congenital abnormalities, or tumors affecting the adrenal glands. In contrast, secondary adrenal insufficiency is often linked to dysfunctions of the pituitary gland or hypothalamus, which regulate hormone production. The test involves measuring cortisol levels, a hormone produced by the adrenal cortex, which plays a vital role in various bodily functions, including metabolism and stress response. The ACTH stimulation test is optimally conducted in the morning, between 8 and 9 a.m., after the patient has consumed a fat-free meal to ensure accurate baseline measurements. During the procedure, a blood sample is collected through venipuncture to determine the baseline cortisol level. Following this, cosyntropin (Cortosyn) is administered intravenously at a dose of 0.25 mg, and the patient is allowed to rest undisturbed for a period of 30 to 60 minutes. A second blood sample is then obtained through another venipuncture to measure the cortisol level after the stimulation. The serum or plasma samples are analyzed using a quantitative chemiluminescent immunoassay, providing critical information regarding adrenal gland function and potential insufficiency.
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The ACTH stimulation panel is indicated for the assessment of adrenal gland function in patients suspected of having adrenal insufficiency. The following conditions may warrant the performance of this panel:
The procedure for the ACTH stimulation panel involves several critical steps to ensure accurate assessment of adrenal function.
After the completion of the ACTH stimulation panel, patients may resume normal activities unless otherwise directed by their healthcare provider. It is important to monitor for any adverse reactions to the cosyntropin injection, although such reactions are rare. The results of the cortisol measurements will be interpreted by the physician to determine the presence and type of adrenal insufficiency, guiding further management and treatment options as necessary.
| Short Descr | ACTH STIMULATION PANEL | Medium Descr | ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY | Long Descr | ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2) | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 235 - Other Laboratory |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q4 | Service for ordering/referring physician qualifies as a service exemption |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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