MTBprime

Primary Panel, MGIT Susceptibility

Laboratory Fee Schedule

Procedure: PZM0001A

CPT: 87188 x 4


Primary Panel, MGIT Susceptibility
Synonym(s): M. tuberculosis complex primary drug panel
Requisition Form G-MYCO
Test Description MGIT drug susceptibility test to Isoniazid @ 0.4 µg/mL,  Isoniazid @ 0.1  µg/mL , Ethambutol and Rifampin
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
Sample/Specimen Type for Testing M. tuberculosis complex 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
  • Two patient-specific identifiers required (e.g., patient full name, date of birth, Medical record number)
  • Identifiers on specimen must exactly match submission form.
Shipping and Specimen Handling Requirements
  • Ship according to Dangerous Goods Regulations, IATA, and/or CFR 49
  • Category A shipping applies
Method MGIT drug susceptibility tests interpreted as either susceptible or resistant to a specific drug at critical concentration recommended by CLSI
Turn-around Time  21 days
Interferences/Limitations
  • Test can only be performed on pure cultures of M. tuberculosis complex
Common Causes for Rejection
  • Non-viable isolates
  • Cultures overgrown by contaminating organisms
  • Isolate not M. tuberculosis complex
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.
  • This laboratory will notify submitter of new drug resistance detected by this test.
 

Last updated February 9, 2022