Laboratory Fee Schedule
Procedure: MAC0055A
CPT: 87143
| Synonym(s): | Mycobacteria, Tuberculosis, TB, NTM, AMRC, AMRF |
|---|
| Requisition Form | G-MYCO |
|---|
| Test Description | Identification of mycobacterial isolates (MTB complex and non-tuberculous mycobacteria) referred to DSHS Laboratory |
|---|
| 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 | Mycobacterium species pure isolate in liquid or on solid culture medium |
|---|
| Minimum Volume/Size Required | - Liquid culture - 2.0 mL
- Solid culture - Single mature 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 A shipping requirements apply to Mycobacterium tuberculosis complex isolates.
- Submitters are responsible for packaging and shipping specimens according to regulatory requirements.
- Additional DSHS Laboratory specimen shipping guidelines online here.
- Ship overnight on cold packs if specimens are refrigerated.
- Ship specimens overnight Monday–Thursday to avoid weekend deliveries.
- Do not ship specimens for holiday or weekend delivery.
- Ensure media used to grow isolates has not expired.
- Additional DSHS Laboratory specimen shipping guidelines online here.
|
|---|
| Method | - High performance liquid chromatography (HPLC)
- Subculture for purity and morphological examination
|
|---|
| Turn-around Time | 2 days for identification |
|---|
| Interferences/Limitations | - HPLC may only detect the predominant organism in a mixed culture.
- Liquid cultures must be instrument positive in order to be analyzed by HPLC.
- Additional testing methods may need to be used to provide definitive identification.
|
|---|
| Common Causes for Rejection | - Cultures overgrown by contaminating organisms.
- Cultures broken in transit.
- Missing identifiers on specimen or submission form.
- Mismatch between specimen and/or submission form identifiers.
|
|---|
| Additional Information | - Most isolates can be identified as either M. tuberculosis complex or Mycobacterium species, not M. tuberculosis within 2 to 3 days.
|
|---|
