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.