Laboratory Fee Schedule
Procedure #: BZZ0008A
CPT: 83020, 83021
| Synonym(s): | Hemoglobinopathy, Hemoglobin Type, or Sickle Cell Screening |
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| Requisition Form | G-1B |
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| Test Description | Testing for hemoglobinopathies and thalassemias, including sickle cell anemia. |
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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) | Human |
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| Sample/Specimen Type for Testing | Dried whole blood on DSHS approved filter paper card. |
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| Minimum Volume/Size Required | One ½ inch dried blood spot |
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| Storage/Preservation Prior to Shipping | - Allow card to dry thoroughly at room temperature in a horizontal position for at least 3 hours. Do NOT allow specimen to touch any surface.
- Cover dried specimen with attached flap.
- Keep specimen away from heat and direct sunlight.
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| Transport Medium | N/A |
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| Specimen Labeling | - Two patient-specific identifiers required (e.g., patient full name, date of birth, medical record number)
- Identifiers on specimen must match submission form exactly
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| Shipping and Specimen Handling Requirements | Ship all specimens according to Dangerous Good Regulations, IATA, and/or CFR 49. Must include one completed G1-B form per specimen. DRIED FILTER PAPER BLOOD SPECIMENS - U.S. Postal regulations require Double containment of dried blood filter paper specimens. Ensure specimens are thoroughly dried prior to placing in envelope.
- 1st containment: Use the attached wrap-around cover with printed universal biohazard symbol. Do not put biohazard labels on outside of envelope.
- 2nd containment: Place dried filter paper blood specimen in an envelope that is not hermetically sealed. Do not put specimens in plastic bags
- Ship as soon as possible; within 24hrs of collection.
- Avoid temperatures greater than 100°F.
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| Method | Isoelectric focusing |
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| Turn-around Time | 7-10 working days after receipt of specimen |
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| Interferences/Limitations | N/A |
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| Common Causes for Rejection | - Use of expired specimen collection device
- No date of collection provided
- Missing/invalid patient demographic information
- Specimen is too old upon receipt (received 14 or more days following collection)
- No blood samples received with request form
- Insufficient blood has been submitted
- Specimen is contaminated or discolored
- Improper specimen submitted (i.e., EDTA whole blood)
- Serum separation due to improper drying or collection
Visit website for complete list. |
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| Additional Information | Additional information for specimen collection: • View a specimen collection training video for collecting on filter paper |
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