Primary Panel, MGIT Susceptibility

Laboratory Fee Schedule
Procedure #: PZM0001A
CPT: 87188 x 4

Synonym(s):	M. tuberculosis complex primary drug panel, MTB, MGIT DST, susceptibility testing
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	14 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.