Laboratory Fee Schedule
Procedure #: MAD0067A
CPT: 87190
| Synonym(s): | M. tuberculosis complex drug susceptibility test (DST), ETO DST, ETH DST |
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| Requisition Form | G-MYCO |
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| Test Description | Susceptibility test to Ethionamide by agar proportion method. |
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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) | Pure isolate from human sources. |
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| Sample/Specimen Type for Testing | M. tuberculosis complex pure isolate in liquid or on solid culture medium. |
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| Minimum Volume/Size Required | - Liquid culture-2.0 mL
- Solid culture-Visible growth, more than a single colony
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| Storage/Preservation Prior to Shipping | Ambient |
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| Transport Medium | N/A |
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| 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.
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| Shipping and Specimen Handling Requirements | - Ship according to Dangerous Goods Regulations, IATA, and/or CFR 49
- Triple-contain in accordance with federal shipping regulations for UN2814 Category A, Infectious substance, affecting humans.
- Anyone who handles Category A substances is required by law to be trained in handling and shipping Category A, Infectious Substances.
- Untrained personnel should not handle or ship M. tuberculosis isolates.
- Submitters are responsible for packaging and shipping specimens according to regulatory requirements.
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| Method | Agar proportion susceptibility test interpreted as either susceptible or resistant to a specific drug at critical concentration recommended by CLSI. |
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| Turn-around Time | 14 to 21 days. |
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| Interferences/Limitations | Test can only be performed on pure cultures of M. tuberculosis complex. |
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| Common Causes for Rejection | - Non-viable isolates.
- Cultures overgrown by contaminating organisms.
- Isolate not M. tuberculosis complex.
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| 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.
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