Laboratory Fee Schedule
Procedure #: MBZ0266A
CPT: 87190
Synonym(s):
| Mycobacteria, M. kans, Rifampin, Susceptibility testing |
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| Requisition Form | G-MYCO |
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| Test Description | Susceptibility to rifampin by agar proportion for M. kansasii |
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| Pre-Approval Needed | N/A |
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| Supplemental Information Required | N/A |
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| Supplemental Form(s) | N/A |
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| Performed on Specimens from (sources) | Pure isolate from human sources. |
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| Pre-Approval Needed | M. kansasii pure isolate in liquid or on solid culture medium. |
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| Minimum Volume/Size Required | - Liquid culture: 2.0 mL
- Solid culture: Visible growth, more than a single colony
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| Storage/Preservation Prior to Shipping | Ambient |
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| Transport Medium | N/A |
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| Specimen Labeling | - At least two patient identifiers required on specimen (e.g., patient full name, date of birth, medical record number).
- Three patient identifiers are preferred.
- Patient identifiers on specimen label must exactly match identifiers on submission form. (e.g., abbreviated name on label and full name on form is not acceptable.)
- Additional DSHS Laboratory specimen labeling guidelines available online here.
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| Shipping and Specimen Handling Requirements | - Ship according to Dangerous Goods Regulations, IATA, and/or CFR 49.
- Category B Biological Substance, UN3373 shipping requirements apply.
- Submitters are responsible for packaging and shipping specimens according to regulatory requirements.
- Additional DSHS Laboratory specimen shipping guidelines online here.
- Ship overnight on cold packs if specimens are refrigerated.
- Ship specimens overnight Monday–Thursday to avoid weekend deliveries.
- Do not ship specimens for holiday or weekend delivery.
- Ensure media used to grow isolates is not expired.
- Additional DSHS Laboratory specimen shipping guidelines online here.
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| Method | Agar proportion susceptibility test interpreted as either susceptible or resistant to a specific drug at critical concentration recommended by CLSI. |
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| Turn-around Time | 14 days |
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| Interferences/Limitations | |
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| Common Causes for Rejection | - Mixed cultures in media.
- Isolate other than M. kansasii.
- Insufficient specimen (non-viable/no growth).
- Missing identifiers on specimen or submission form.
- Mismatch between specimen and/or submission form identifiers.
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| Additional Information | - Isolates submitted for this test will be identified by the DSHS Laboratory.
- No fee will be charged for identification unless identification is requested on the G-MYCO requisition form.
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