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Test Code TSHPL Thyroid-Stimulating Hormone (TSH) with Reflex to FT4, Plasma or Serum

Additional Codes

Ordering Mnemonic




Reflex Information:

If the TSH falls outside of the reference values, the #90410 “T4 (Thyroxine), Free, Plasma or Serum” will be performed at an additional charge.

Performing Laboratory

Holland Hospital Laboratory Services

Specimen Requirements

Specimen must arrive within 48 hours of draw.


Submit only 1 of the following specimens:



Container/Tube: Mint-top (lithium heparin) tube(s)

Specimen Volume: 1 mL of plasma

Collection Instructions:

Note: 1. Indicate plasma.

2. Label specimen appropriately (plasma).



Container/Tube: Serum gel tube(s)

Specimen Volume: 1 mL of serum

Collection Instructions:

Note: 1. Indicate serum.

2. Label specimen appropriately (serum).

Specimen Transport Temperature

Refrigerate ≤48 hours/Frozen OK

Day(s) Test Set Up

Monday through Sunday

Test Classification and CPT Coding


84439-T4 free (if appropriate)

Reference Values

0.34-5.1 µIU/mL