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22655 General Health Panel (HGMPA, TSH, MPC)

General Health Panel (HGMPA, TSH, MPC)
Test Code: GHP
Test Components
Test Panel includes CBC with automated differential, thyroid stimulating hormone, and complete metabolic panel​
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No
Plasma/Serum
AND
Whole Blood​
Lithium-heparin Plasma Separator (PST),
AND
EDTA Lavender Top (LTT)​
Serum Separator Tube (SST),
Lithium or Sodium-heparin Green Top (GTT)​
2 mL  Plasma/Serum
AND
3 mL EDTA whole blood​
1 mL  Plasma/Serum
AND
1 mL EDTA whole blood​
 ​
Specimen Stability Information
Specimen Type Temperature Time
Plasma/Serum​ Ambient 8 hours
Refrigerate​ 2 days​
Frozen 30 days
Rejection Criteria
Grossly hemolyzed samples
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Chippewa Falls​Monday through Friday2 hours​See individual tests for Methodology
​Diagnostic Treatment Center ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
​Eau Claire ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
Ladysmith Medical Center​​Monday through Sunday​​Less than 2 hours​​See individual tests for Methodology
​Lakeview Medical Center ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
Marshfield​ Monday through Sunday​ Less than 2 hours​ ​See individual tests for Methodology
​Minocqua ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
Neillsville​​Monday through Sunday​Less than 2 hours​​See individual tests for Methodology
Stevens Point​ ​Monday through Friday ​Less than 2 hours​ ​​See individual tests for Methodology
​Wisconsin Rapids ​Monday through Friday ​Less than 2 hours​ ​​See individual tests for Methodology
Test Information
This panel includes: Comprehensive Metabolic Panel (MPC), TSH, and CBC with Auto Differential (HGMPA). Medicare considers this a screening panel and therefore will not pay for this panel.  The Individual tests will be covered by Medicare for diagnostic purposes per their coverage policies.​
Reference Range Information
Performing Location Reference Range
All Performing Sites See individual test listings for reference ranges​
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80050 ​ ​ ​ ​ ​
Test Components
Test Panel includes CBC with automated differential, thyroid stimulating hormone, and complete metabolic panel​
Ordering Applications
Ordering Application Description
​Centricity ​None
​Cerner ​General Health Panel
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No
Plasma/Serum
AND
Whole Blood​
Lithium-heparin Plasma Separator (PST),
AND
EDTA Lavender Top (LTT)​
Serum Separator Tube (SST),
Lithium or Sodium-heparin Green Top (GTT)​
2 mL  Plasma/Serum
AND
3 mL EDTA whole blood​
1 mL  Plasma/Serum
AND
1 mL EDTA whole blood​
 ​
Specimen Stability Information
Specimen Type Temperature Time
Plasma/Serum​ Ambient 8 hours
Refrigerate​ 2 days​
Frozen 30 days
Rejection Criteria
Grossly hemolyzed samples
Test Components
Test Panel includes CBC with automated differential, thyroid stimulating hormone, and complete metabolic panel​
Reference Range Information
Performing Location Reference Range
All Performing Sites See individual test listings for reference ranges​
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Chippewa Falls​Monday through Friday2 hours​See individual tests for Methodology
​Diagnostic Treatment Center ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
​Eau Claire ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
Ladysmith Medical Center​​Monday through Sunday​​Less than 2 hours​​See individual tests for Methodology
​Lakeview Medical Center ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
Marshfield​ Monday through Sunday​ Less than 2 hours​ ​See individual tests for Methodology
​Minocqua ​Monday through Sunday​ ​Less than 2 hours​ ​​See individual tests for Methodology
Neillsville​​Monday through Sunday​Less than 2 hours​​See individual tests for Methodology
Stevens Point​ ​Monday through Friday ​Less than 2 hours​ ​​See individual tests for Methodology
​Wisconsin Rapids ​Monday through Friday ​Less than 2 hours​ ​​See individual tests for Methodology
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80050 ​ ​ ​ ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.