AFB – Mycobacterium kansii, Rifampin Susceptibility by Agar Proportion

Laboratory Fee Schedule
Procedure #: MBZ0266A
CPT: 87190

Synonym(s):	Mycobacteria, M. kans, Rifampin, Susceptibility testing
Requisition Form	G-MYCO
Test Description	Susceptibility to rifampin by agar proportion for M. kansasii
Pre-Approval Needed	N/A
Supplemental Information Required	N/A
Supplemental Form(s)	N/A
Performed on Specimens from (sources)	Pure isolate from human sources.
Pre-Approval Needed	M. kansasii pure isolate in liquid or on solid culture medium.
Minimum Volume/Size Required	Liquid culture - 2.0 mL Solid culture - Visible growth, more than a single colony.
Storage/Preservation Prior to Shipping	Ambient
Transport Medium	N/A
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.
Shipping and Specimen Handling Requirements	Ship according to Dangerous Goods Regulations, IATA, and/or CFR 49. Category B shipping applies
Method	Agar proportion susceptibility test interpreted as either susceptible or resistant to a specific drug at critical concentration recommended by CLSI.
Turn-around Time	14 days
Interferences/Limitations
Common Causes for Rejection	Mixed cultures Isolate other than M. kansasii Insufficient sample (non-viable/no grow Missing identifiers on specimen or submission form Mismatch between specimen and/or submission form identifiers
Additional Information	Isolates submitted for this test will be identified by this laboratory. No fee will be charged for this identification unless identification is requested on the G-MYCO requisition form.