Nicotine / Cotinine Test
Urine test that detects nicotine use and measures cotinine levels to determine recent tobacco or nicotine product exposure.
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LevelPanel has no business or affiliate relationship with Quest or LabCorp. These links are provided as a public service.
Lab testing services linked from this site are not available to residents of Alaska, Arizona, or Hawaii, unless otherwise noted on the lab's own website.
This publication is not intended to solicit the purchase of laboratory testing from any individual consumer.
What this test measures
This urine test measures cotinine, the primary metabolite produced when the body breaks down nicotine. Cotinine is formed in the lungs, liver, and kidneys and remains detectable in the body for substantially longer than nicotine itself. While nicotine clears the bloodstream within a few hours of exposure, cotinine persists for several days, making it a far more reliable indicator of recent tobacco or nicotine use.
Cotinine concentrations in urine are four to six times higher than those found in blood or saliva, which gives urine testing the greatest sensitivity for detecting nicotine exposure. The test is widely used to distinguish tobacco users from non-users, verify smoking cessation, assess secondhand smoke exposure, and support insurance or employment screenings. Because cotinine reflects the extent of nicotine exposure rather than simply its presence, the quantitative result can provide insight into the level of use, from light occasional exposure to heavy daily consumption.
Who should consider this test
You might consider this test if you are experiencing any of the following:
- Individuals participating in smoking cessation programs who need to verify abstinence from tobacco products
- Those applying for life insurance policies that require nicotine testing as part of the medical exam process
- Patients scheduled for surgery, as many procedures require nicotine-free status for optimal healing outcomes
- People who suspect they may have significant exposure to secondhand smoke and want objective confirmation
- Individuals on nicotine replacement therapy who want to monitor their cotinine levels during treatment
- Those required to demonstrate tobacco-free status for employment, organ transplant qualification, or other medical purposes
What to expect
Preparation
No special preparation is required for this test. Individuals do not need to fast or avoid any foods or medications before testing. The test can be taken at any time of day.
Sample Type
This test requires a urine sample, which is collected in a sterile container provided by the laboratory.
Collection
Sample collection takes place at a Quest Diagnostics or LabCorp patient service center. The collection process is simple and typically completed within a few minutes, with no doctor visit required.
Turnaround
Results are typically available within 1-2 business days from when the laboratory receives the sample.
Understanding your results
Results are reported as detected or not detected, along with a quantitative cotinine concentration. The cutoff used to distinguish a tobacco user from a non-user is typically set between 10 and 15 ng/mL, though urine cotinine values in active tobacco users commonly range from 20 to 550 ng/mL or higher depending on consumption level. A result below the cutoff is consistent with non-use or minimal passive exposure, while a result above the cutoff indicates meaningful nicotine exposure. Healthcare providers may use quantitative results to estimate the degree of exposure and to monitor progress during smoking cessation efforts.
| Population | Reference Range | Notes |
|---|---|---|
| Non-tobacco users (no exposure) | Less than 1 ng/mL | Indicates no recent nicotine exposure |
| Passive exposure (secondhand smoke) | 1-20 ng/mL | May indicate exposure to environmental tobacco smoke |
| Active tobacco users | 1,000-8,000 ng/mL | Indicates recent active use of tobacco or nicotine products |
Reference ranges shown are general guidelines. Your lab report will include the specific reference range used by the laboratory that processed your sample, which is the authoritative range for interpreting your results.
What does a “Low” result mean?
Non-users who report no secondhand smoke exposure generally have levels below 1 ng/mL, while minor passive exposure may raise levels up to 5 ng/mL. If someone smokes but goes 2 weeks without nicotine exposure before testing, they may show urine cotinine levels of less than 50 ng/mL. Low or undetectable cotinine levels typically suggest either no recent nicotine exposure or successful abstinence from tobacco products. However, some individuals may still have trace amounts due to environmental exposure or individual differences in metabolism.
What does a “High” result mean?
Urine cotinine in the range of 1000 to 8000 ng/mL typically indicates the individual is either actively using a tobacco product or on high-dose nicotine patch therapy. Cotinine accumulates in urine in proportion to dose and hepatic metabolism, and most tobacco users excrete cotinine in this elevated range. If someone is a current smoker, urine cotinine levels may be 1,000 to 8,000 nanograms per milliliter. Elevated levels may suggest recent tobacco use, heavy smoking, or use of nicotine replacement products, though the specific cause requires clinical interpretation.
Privacy & confidentiality
All test orders are authorized and results reviewed by an independent, board-certified physician who is not the patient's personal doctor. Your nicotine/cotinine test results are completely confidential and private. These results are <u>not reported to your doctor</u> unless you specifically choose to share them, and they are <u>not part of your medical records</u> maintained by your healthcare provider. The test results will <u>not appear on insurance statements</u> or explanation of benefits (EOB) forms, ensuring your privacy is protected from insurance companies and employers. This confidential testing allows individuals to assess their nicotine exposure status privately, whether for personal health monitoring, insurance applications, or smoking cessation program verification. Your results are securely delivered directly to you, maintaining complete discretion about your nicotine use status without any third-party involvement or reporting requirements.
Frequently asked questions
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Last reviewed: April 2026
CPT Code: 82486
This test may not be available in: NY, NJ, RI
This page is for informational purposes only and does not constitute medical advice. Always consult with a healthcare provider regarding any health concerns. LevelPanel does not diagnose, treat, or prescribe.
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LevelPanel has no business or affiliate relationship with Quest or LabCorp. These links are provided as a public service.
Lab testing services linked from this site are not available to residents of Alaska, Arizona, or Hawaii, unless otherwise noted on the lab's own website.
This publication is not intended to solicit the purchase of laboratory testing from any individual consumer.
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