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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