hCG Blood Test Cost and Medicare Coverage (CPT 84702)

Also called: beta hCG · quantitative hCG · hCG, total, quantitative · human chorionic gonadotropin · pregnancy blood test · hCG tumor marker — all the same test, CPT 84702.

The short answer

Covered for two things: diagnosing and following certain tumors, and monitoring a pregnancy that is in trouble. Medicare’s national policy (NCD 190.27, the same in every state) is three sentences long on what it covers: “Human Chorionic Gonadotropin (hCG) is useful for monitoring and diagnosis of germ cell neoplasms of the ovary, testis, mediastinum, retroperitoneum, and central nervous system. In addition, hCG is useful for monitoring pregnant patients with vaginal bleeding, hypertension and/or suspected fetal loss.”

Then it sets the limits: “It is not reasonable and necessary to perform hCG testing more than once per month for diagnostic purposes. It may be performed as needed for monitoring of patient progress and treatment. Qualitative hCG assays are not appropriate for medically managing patients with known or suspected germ cell neoplasms.”

Most people know hCG as the pregnancy hormone, and a routine pregnancy check is not on the policy’s list at all. The policy’s pregnancy language is about monitoring a pregnancy with a named complication, not confirming one. For Medicare’s purposes, this is mainly a tumor marker: the National Cancer Institute lists beta-hCG for “choriocarcinoma and germ cell tumors,” used “to assess stage, prognosis, and response to treatment.”

When Medicare DOES cover it

The national policy’s covered picture, in plain English:

• Diagnosing or following a germ cell tumor. The policy names the sites: ovary, testis, mediastinum (the middle of the chest), retroperitoneum (the back of the abdomen), and central nervous system. Quest’s directory notes that hCG is secreted “with pathologic conditions such as hydatidiform mole, choriocarcinoma and testicular neoplasm,” and Cleveland Clinic says “germ cell tumors or other cancer cells can cause your body to make hCG.”
• Monitoring treatment. The policy allows the test “as needed for monitoring of patient progress and treatment,” with no monthly cap for that purpose. NCI’s list says the marker is used to assess “response to treatment.”
• Monitoring a pregnancy with a complication. The policy’s words: “pregnant patients with vaginal bleeding, hypertension and/or suspected fetal loss.” The MedlinePlus encyclopedia describes the quantitative test being used to help diagnose ectopic pregnancy and miscarriage.
• The quantitative version, specifically. For tumor work the policy rules out the yes-or-no test: “Qualitative hCG assays are not appropriate for medically managing patients with known or suspected germ cell neoplasms.” CPT 84702 is the quantitative test, the one that reports a number.

If one of these genuinely describes your situation, the diagnosis for it belongs on your doctor’s order, and coverage follows.

When Medicare does NOT cover it

• A routine pregnancy check. The policy covers monitoring a pregnancy with bleeding, high blood pressure, or suspected loss. A quantitative hCG ordered simply to confirm a pregnancy has no covered indication in this policy.
• More than once a month for diagnosis. “It is not reasonable and necessary to perform hCG testing more than once per month for diagnostic purposes.” The exception is monitoring, which “may be performed as needed.”
• Screening. The policy never uses the word, and it lists no covered use for someone with no tumor suspected and no pregnancy complication. MedlinePlus says a provider “may also order a quantitative hCG blood test to help diagnose or monitor health conditions that aren’t related to pregnancy,” naming ovarian and testicular cancer; that is the covered situation, and it starts with a suspicion on the chart.
• Other cancers. The policy names germ cell tumors at five sites. It says nothing about any other cancer, which means there is no covered indication in the policy for them.

(Never ask anyone to change a code just to get coverage; that is fraud. But doctors often have a legitimate reason for the test that simply wasn’t written down.)

What you pay if it IS covered: $0

Covered lab tests cost Medicare patients nothing, with no deductible and no 20% coinsurance. Medicare pays the lab $15.05 for a quantitative hCG test, and you owe zero.

What you pay if it is NOT covered, read this before you sign

Quest’s own test directory flags the quantitative hCG as “subject to a Medicare Limited Coverage Policy” that “may require a signed ABN when ordering.” (Labcorp’s page carries no such notice.) If hCG is on your order without a germ cell tumor diagnosis or a pregnancy complication behind it, expect the Advance Beneficiary Notice (ABN), the signature pad, committing you to the lab’s own billing rates if Medicare denies the claim. Before you sign:

1. Ask the lab to print exactly what you would owe. You’re entitled to see the number in black and white first. For perspective: when Medicare covers this exact test, it pays the lab $15.05.
2. Ask whether it has been a month. If this is a diagnostic hCG and the last one was less than a month ago, the policy’s limit applies unless the order is for monitoring treatment.
3. Know the direct prices: a quantitative hCG sells for $20 at Jason Health (jasonhealth.com, plus their flat $18 lab-collection fee per order, so $38 all in), $36.95 at Ulta Lab Tests (partner link in the table; our commission is disclosed there; add their $12.95 draw fee), $39.90 at Personalabs, $49 at Labcorp OnDemand, and $55 at Quest’s consumer site plus a $6 physician fee. Same certified labs, same blood draw.

Before you sign the pad, 60-second checklist

1. Ask: “Can you print what I’ll owe if Medicare doesn’t pay?”
2. Ask your doctor: “Is this for a germ cell tumor, or a pregnancy complication, and is that diagnosis on the order?”
3. Compare the printed price to the direct-purchase prices before deciding how to proceed.

What counts as a “normal” hCG level

Start with the range printed on your own report. For anyone who is not pregnant, the published reference values are low and the labs nearly agree.

Quest’s directory hides its range until a service area is chosen. In pregnancy the expected value is a different question entirely, because the number climbs by the week: Cleveland Clinic says “hCG increases quickly (almost doubling every three days) for the first eight to 10 weeks of pregnancy,” and prints a table that runs from 5 to 50 mIU/mL at three weeks to tens or hundreds of thousands by the end of the first trimester. The MedlinePlus encyclopedia says results are compared with “expected ranges varying by gestational week.”

None of the sources we checked gives a treatment target for hCG, so there is no “clinical target” to add here. The caution NCI attaches to every tumor marker applies: an elevated result “does not mean that someone has cancer,” and marker results “are usually combined with the results of other tests, such as biopsies or imaging.” The MedlinePlus encyclopedia lists several non-cancer reasons a level can be higher than expected, including a multiple pregnancy and a hydatidiform mole.

(Where lab ranges and “optimal” ranges come from, and who decides.)

This page can tell you where those numbers came from. It cannot tell you what yours means; that reading belongs to your doctor, alongside your imaging, your earlier levels, and your history.

Quick questions people ask

What is an hCG blood test? Cleveland Clinic: “Human chorionic gonadotropin (hCG) is a hormone the placenta makes during pregnancy.” The MedlinePlus encyclopedia says “a quantitative human chorionic gonadotropin (HCG or hCG) blood test measures the specific level of HCG in the blood.” Quest’s directory calls it “a glycoprotein hormone produced by the syncytiotrophoblast of the placenta and secreted during normal pregnancy and with pathologic conditions such as hydatidiform mole, choriocarcinoma and testicular neoplasm.” On billing paperwork the quantitative test is CPT code 84702.

What is the difference between a quantitative and a qualitative hCG test? MedlinePlus: “A quantitative blood test measures the exact amount of hCG in your blood, and a qualitative hCG blood test simply tells you whether you are pregnant or not.” The qualitative test has a different CPT code, and Medicare’s policy rules it out for tumor management: “Qualitative hCG assays are not appropriate for medically managing patients with known or suspected germ cell neoplasms.”

Why would an hCG test be ordered for a man? Because it is a tumor marker. NCI lists beta-hCG for “choriocarcinoma and germ cell tumors,” and Quest’s directory names testicular neoplasm among the conditions that raise it. Labcorp’s reference interval for men is 0 to 3 mIU/mL, so a measurable level in a man is a result for a doctor to interpret. Medicare’s covered sites include the testis, mediastinum, retroperitoneum, and central nervous system.

How early can a blood test detect pregnancy? Quest’s directory says “hCG may reach detectable limits within 7-10 days of conception,” and MedlinePlus says blood tests “can find very small amounts of hCG and show whether you’re pregnant before you’ve missed your period.” Whether Medicare pays for that check is a separate question, and under this policy the answer is no unless a complication is being monitored.

Do you have to fast for an hCG blood test? No. The MedlinePlus encyclopedia says “no special preparation is needed,” Quest’s directory lists patient preparation as “none specified,” and Ulta’s page says the same. Labcorp adds that high-dose biotin supplements can interfere with the assay and asks patients to stop biotin at least 72 hours before the draw.

Sources and data dates

Medicare payment amount: CMS Clinical Laboratory Fee Schedule, 2026 Q3 file (national rate for 84702). Coverage rules: CMS Medicare Coverage Database, NCD 190.27 (Human Chorionic Gonadotropin), a national policy identical in every state, and the same text in the NCD Manual, Chapter 1, Part 3. Test descriptions, preparation, and ranges: National Cancer Institute (Tumor Marker Tests in Common Use), MedlinePlus (Pregnancy Test; HCG blood test - quantitative), Cleveland Clinic (Human Chorionic Gonadotropin), Quest test 8396, Labcorp test 004416. Consumer prices checked September 2026. Information current as of the date shown above; coverage is always determined by Medicare when your claim is processed.

ClaraCover provides information, not medical, billing, or insurance advice. Talk to your doctor about what tests you need.