Hemoglobin Electrophoresis


Hemoglobin Electrophoresis

Laboratory Fee Schedule

Procedure #:  BZZ0008A

CPT:  83020, 83021

Hemoglobin Electrophoresis
 Synonym(s):  Hemoglobinopathy, Hemoglobin Type, or Sickle Cell Screening
 Requisition Form G-1B or G-THSTEPS
 Test Description Testing for clinically significant hemoglobinopathies and thalassemias, including sickle cell anemia.
 Pre-Approval Needed N/A
 Supplemental Information   Required N/A
 Supplemental Form(s) N/A
 Performed on Specimens from   (sources) Human
 Sample/Specimen Type for Testing Dried whole blood on DSHS approved filter paper card.
 Minimum Volume/Size Required One - two completely filled ½ inch dried blood spots
 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.
 Transport Medium N/A
 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
 Shipping and Specimen Handling   Requirements Ship all specimens according to Dangerous Good Regulations, IATA, and/or CFR 49. 

 Must include one completed requisition form (G-1B or G-THSTEPS as appropriate) 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. 
 Method Isoelectric focusing
 Turn-around Time 7-10 working days after receipt of specimen
 Interferences/Limitations N/A
 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.

 Additional Information Additional information for specimen collection:


Last updated June 10, 2022