Biochemical Laboratory Tests, CPT Codes, and Prices

Transcription

Biochemical Laboratory Tests, CPT Codes, and Prices
Children’s Hospital Colorado – Anschutz Medical Campus
Department of Pathology and Laboratory Medicine
Biochemical Genetics Laboratory
www.DenverGenetics.org
Phone: 720-777-0500
Fax: 720-777-7877
13123 East 16th Avenue B120 | Aurora, CO 80045
Address:
Children’s Hospital Colorado
Clinical Laboratory – Biochemical Genetics
13123 East 16th Avenue B120
Aurora, CO 80045
Couriers: Use the street address above, Room B0200
Telephone: (720) 777-0500
Fax: (720) 777-7877
Web: www.DenverGenetics.org
All plasma samples should be heparinized (collected in green-topped tubes)
PLEASE NOTE: REFERRAL SOURCE IS RESPONSIBLE FOR PAYMENT
WE DO NOT BILL PATIENTS OR THEIR INSURANCE COMPANIES
STAT test policy:
Tests are run STAT only by advance agreement via telephone with the lab director. An additional $50.00 fee is charged for each
test run STAT. Results for tests run STAT will be available no later than
24 hours after specimen arrival in this laboratory.
$45.00 1
$125.00
$100.00
$100.00
$100.00
$100.00
Sample
Size (mL)
0.3
0.3
0.3
0.3
0.3
0.3
CPT
Codes
82128
82139
82136
82131
82131
82131
Frozen
$100.00
0.3
82136
Urine amino acid/cystine screen 1
Urine amino acids (quant.)
Urine aspartylglucosamine (qual.)
Urine S-sulfo-cysteine (semi-quant.)
Urine phosphoethanolamine (quant.)
Ambient
Frozen
Frozen
Frozen
Frozen
$45.00 1
$125.00
$100.00
$100.00
$100.00
2.0
2.0
2.0
2.0
2.0
82128
82139
82131
82131
82131
CSF amino acids (quant.)
CSF glycine (quant.)
CSF glutamine (quant.)
Frozen
Frozen
Frozen
$125.00
$100.00
$100.00
0.3
0.3
0.3
82139
82136
82136
Urine mucopolysaccharide screen
Ambient
$50.00
10.0
88313
Serum (or plasma) phytanic acid (quant.)
Serum (or plasma) benzoic acid (quant.)
Serum (or plasma) glutaric & 3-hydroxyglutaric acids (quant.)
Serum (or plasma) methylmalonic acid (quant.)
Serum (or plasma) N-acetylaspartic acid (quant.)
Frozen
Frozen
Frozen
Frozen
Frozen
$150.00
$150.00
$200.00
$150.00
$150.00
1.0
1.0
1.0
1.0
1.0
82543
82543
82544
82543
82543
Test
Serum (or plasma) amino acid screen 1
Serum (or plasma) amino acids (quant.)
Serum (or plasma) branched-chain AA (quant.)
Serum (or plasma) alanine (quant.)
Serum (or plasma) methionine (quant.)
Serum (or plasma) Glycine (quant.)
Serum (or plasma) phenylalanine and
tyrosine (quant.)
Shipping
Temperature
Ambient
Frozen
Frozen
Frozen
Frozen
Frozen
Price
Online: www.DenverGenetics.org
Rev. 1/14/2015
Children’s Hospital Colorado – Anschutz Medical Campus
Department of Pathology and Laboratory Medicine
Biochemical Genetics Laboratory
www.DenverGenetics.org
Phone: 720-777-0500
Fax: 720-777-7877
13123 East 16th Avenue B120 | Aurora, CO 80045
Children’s Hospital Colorado Clinical Laboratory—Biochemical Genetics
STEPHEN I. GOODMAN, MD
All plasma samples should be heparinized (collected in green-topped tubes)
PLEASE NOTE: REFERRAL SOURCE IS RESPONSIBLE FOR PAYMENT
WE DO NOT BILL PATIENTS OR THEIR INSURANCE COMPANIES
Test
Urine organic acid screen
Urine succinylacetone (quant.)
Urine orotic acid (quant.)
Urine phenylpropionylglycine and hexanoylglycine (quant.)
Urine glutaric & 3-hydroxyglutaric acids (quant.)
Urine ethylmalonic acid (quant.)
Urine methylmalonic acid (quant.)
Urine N-acetylaspartic acid (quant.)
Urine 3-methylglutaconic acid (quant.)
Urine D- and L- isomers of 2-hydroxyglutaric acid (qual.)
Shipping
Temperature
Ambient
Frozen
Frozen
Frozen
Frozen
Frozen
Frozen
Frozen
Frozen
Frozen
2
CPT
Code
83919
82543
82543
82544
82544
82543
82543
82543
82543
82541
Amniotic fluid glutaric & 3-hydroxyglutaric acids (quant.)
(prenatal; cell-free supernatant). 2
Frozen
$450.00
2.0
82544
Amniotic fluid methylmalonic acid (quant.) (prenatal; cell-free
supernatant). 2
Amniotic fluid succinylacetone (quant.) (prenatal; cell-free
supernatant). 2
Frozen
$450.00
2.0
82543
Frozen
$450.00 2
2.0
82543
Urine or CSF Bratton-Marshall test (succinylpurines, qual.)
Frozen
$25.00
1.0
84311
$105.00
$250.00
$25.00
0.2
1.0
Card
82016
82544
82541
Plasma (or serum) acylcarnitine profile (qual.)
Frozen
Urine trimethylamine (TMA) and TMA N-oxide (TMAO) (quant.) Frozen
Expanded newborn screen
Ambient
1
$120.00
$150.00
$150.00
$150.00
$200.00
$150.00
$150.00
$150.00
$150.00
$375.00
Sample
Size (mL)
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
2.0
5.0
Price
Total charge for serum (or plasma) plus urine amino acid screens is $45.00 if both are received
together. If a serum amino acid screen is ordered and urine from the same patient is also provided,
then a urine amino acid screen will automatically be added and performed at no additional charge.
Cell-free supernatant required. Include two controls of same gestational age (14-16 weeks)
with patient sample, all labeled blind (i.e. numbers but no names). Consultation required before
sending specimens.
Children’s Hospital Colorado Clinical Laboratory—Biochemical Genetics
Online: www.DenverGenetics.org
Rev. 1/14/2015
Children’s Hospital Colorado – Anschutz Medical Campus
Department of Pathology and Laboratory Medicine
Biochemical Genetics Laboratory
www.DenverGenetics.org
Phone: 720-777-0500
Fax: 720-777-7877
13123 East 16th Avenue B120 | Aurora, CO 80045
STEPHEN I. GOODMAN, MD
All plasma samples should be heparinized (collected in green-topped tubes)
PLEASE NOTE: REFERRAL SOURCE IS RESPONSIBLE FOR PAYMENT
WE DO NOT BILL PATIENTS OR THEIR INSURANCE COMPANIES
Shipping
Temperature
3, 5
Fibroblast enzyme assay for GA I
Ambient
3, 5
Combined fibroblast enzyme assays for GA II (MADD)
Ambient
Leukocyte enzyme assay for VLCAD deficiency 6
Wet ice – not
frozen
Leukocyte combined enzyme activity and mutation analysis for
Wet ice – not
VLCAD deficiency 7
frozen
Glycine cleavage enzyme assay 4
Frozen
Mitochondrial respiratory chain enzyme regular assay (muscle or Frozen on Dry
liver tissue specimen >60 mg) 4
Ice
5
Mitochondrial respiratory chain enzyme assay – skin fibroblasts Ambient
Test
Mitochondrial respiratory chain enzyme microassay
(liver
tissue specimen 20-60 mg) 4
Blue native electrophoresis with in-gel mitochondrial enzyme
analysis – muscle 4
Blue native electrophoresis with in-gel mitochondrial enzyme
analysis - skin fibroblasts 5
Price
Sample
$600.00
fibroblasts
$1,200.00 fibroblasts
$990.00
whole
blood 5 ml
$1,700.00 whole
82657 81406
blood 5 ml
$600.00
liver
82658 82657
$750.00
muscle/liver 82657 x 6
$1,090.00 fibroblasts
Frozen on Dry $1,000.00 liver
Ice
Frozen on Dry $800.00
muscle
Ice
Ambient
$1,150.00 fibroblasts
Combined mitochondrial respiratory chain enzyme assay and blue Frozen on Dry $1,300.00 muscle
native electrophoresis with in-gel mitochondrial enzyme analysis Ice
- muscle 4
Combined mitochondrial respiratory chain enzyme assay and blue Ambient
$1,550.00 fibroblasts
native electrophoresis with in-gel mitochondrial enzyme analysis
- skin fibroblasts 5
Pyruvate dehydrogenase enzyme assay – skin fibroblasts 5
Ambient
CPT
Code(s)
82658
82657
82657
$750.00
fibroblasts
82657 x 6
88233 x 1
88240 x 1
82657 x 6
82657 x 4
82664 x 1
82657 x 4
82664 x 1
88233 x 1
88240 x 1
82657 x 10
82664 x 1
82657 x 10
82664 x 1
88233 x 1
88240 x 1
82657 x 1
82658 x 1
88233 x 1
88240 x 1
4
Tissue specimens must be immediately frozen on dry ice, stored at -70oC, and shipped frozen on dry
ice. Minimum 60 mg muscle tissue required, 120 mg recommended. Minimum 20 mg liver tissue required
(microassay required if <60 mg).
5
An additional fee of $460 will be charged for skin specimens that have not been cultured into
confluent fibroblasts before shipment.
6
Cost is $330 for each parent. Whole blood is required, collected in a purple cap (EDTA) tube (6.0 mL pediatric
minimum; 10.0 mL adult minimum). Store and ship specimens on wet ice (not frozen).
7
Combination test for proband only -- no parents. Do not include an unrelated control on the combined test. Whole
blood is required, collected in a purple cap (EDTA) tube (6.0 mL pediatric minimum; 10.0 mL adult minimum). Store
and ship specimens on wet ice (not frozen).
Online: www.DenverGenetics.org
Rev. 1/14/2015

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