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This system library was created by the Publishing feature to store pages that are created in this site.

Name
  
Test Code
  
Lab Description
  
Contact
  
Checked Out To
  
Is Primary Sendout
  
IsSecondary
  
Primary Sendout ID
  
Primary Sendout Name
  
Addl Ref Lab Link
  
Specimen Requirements
Version
  
Modified
  
Modified By
  
CPT Codes
  
A1ALCSO Alpha-1-Antitrypsin Proteotype S/Z by LC-MS/MS, Serum (A1ALC)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​1.25 mL ​0.5 mL ​
4.06/22/2022 9:20 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​82103 ​ ​1 ​ ​
​82542 ​ ​1 ​ ​
​82104 ​ ​1 ​ If needed​
  
HER2FSO HER2 Amp, Breast Cancer, FISH, Tissue (H2BR)wroblewj@mfldclin.org
YesNo
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 ​Tissue ​Tissue Block ​ ​ ​ ​
​No ​Slides ​ ​ ​4un, 1 H&E ​2un, 1 H&E ​
8.06/22/2022 9:42 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
88377 ​ ​1 ​
88361 ​ ​1 ​HER Breast IHC Automated No Reflex ​if appropriate
  
DCORTSO11-Deoxycortisol, Serum (DCORT)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL​0.4 mL​
1.02/11/2022 12:11 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​82634​​1​​
  
17OHPSO17-Hydroxypregnenolone, Serum (17OHP)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​1 mL ​0.5 mL ​
6.06/22/2022 1:36 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​84143 ​ ​1 ​ ​
  
FGLIOSO1p19q Deletion in Gliomas, FISH, Tissue (GLIOF)wroblewj@mfldclin.org
YesNo
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 ​​Tissue ​Tissue Block ​ ​ ​ ​
​No ​Slides​​​Six consecutive, unstained and 1 hematoxylin and eosin-stained slide​​
7.06/22/2022 1:40 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​88271

2

 ​DNA probe, each ​
​88291 ​ ​1 ​Interpretation and Report ​
​88271 ​ 1 ​Probe, +1 ​if needed
​88271 ​ ​2 ​Probe, +2 ​if needed
​88271 ​ ​3 ​Probe, +3 ​if needed
​88271 ​ ​2 ​Probe set, count ​if needed
​88274 ​ ​1 ​Interphases, 25-99 ​if needed
​88275 ​ ​1 ​Interphases, 100-300 ​if needed
​88274 ​ ​1 ​Interphases, <25 ​if needed
  
21HDRSO21-Hydroxylase Ab, S (21OH)Potter, Joli K
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ Serum Separator Tube (SST)​ 1 mL​ 0.20 mL​ ​
15.06/22/2022 1:42 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
83516 ​ ​ ​ ​
  
F5NULSO5' Nucleotidase (F5NUL)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​1 mL ​0.5 mL ​
6.06/22/2022 1:45 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​83915 ​ ​1 ​ ​
  
HIAASO5-Hydroxyindoleacetic Acid 24 Hr U (HIAA)wroblewj@mfldclin.org
YesNo
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​*Dietary Restrictions and Drug Interactions ​Urine from 24-hour urine collection
 ​10 mL Urine Tube ​Plastic Urine Container ​5 mL ​1 mL ​1 mL
Note:  Add 25 mL of 50% acetic acid as preservative at start of collection. Use 15 mL of 50% acetic acid for children <5 years old.​​​​​​​​
​ ​ ​ ​ ​ ​
8.02/7/2023 1:33 PMcareygej@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
83497​ ​ ​1 ​ ​
  
HEROIN6-Monoacetylmorphine (Heroin Metabolite), UrineSchalow, Dianne M
NoNo
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​ Urine​ Sage urine collection container​ Sterile plastic container with no preservatives​ 10 mL​ 7 mL​ 4 mL​
20.010/27/2022 4:16 PMcareygej@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
80356 ​ 1​ 6-Monoacetylmorphine (Heroin Metabolite) Confirmation ​
G0480​ ​ 1​ 6-Monoacetylmorphine (Heroin Metabolite) Confirmation For Marshfield Clinic and Medicare/Medicaid​
  
ACETAAcetaminophenPotter, Joli K
NoNo
Fasting RequiredSpecimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​NoPlasma/Serum​Lithium-heparin Plasma Separator Tube (PST)

Serum Separator Tube (SST)

Red Top Tube (RTT)

Lithium or Sodium-heparin Green Top Tube (GTT)
 
EDTA Lavender Top Tube (LTT)​
0.5 mL​0.3 mL​​
26.01/5/2021 2:44 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
80143​ ​ ​1 ​ ​
  
MISCAcetoacetate, Serum/Plasma (0060SP)busedj@mfldclin.org
NoNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
​​(no repeat)
​Serum ​Red Top Tube (RTT) ​ ​3 mL ​1.2 mL
​Plasma ​EDTA Lavender Top Tube (LTT) ​ ​3 mL ​1.2 mL
3.02/25/2020 12:54 PMdrexlerk@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comment​​s
​82010 ​ ​ ​ ​
  
ACRBAcetylcholine Receptor Binding Ab (ARBI)Potter, Joli K
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Serum Red Top Tube (RTT)​ Serum Separator Tube (SST)​ 1.5 mL​ 1.0 mL​ ​
21.06/22/2022 11:55 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​83519 ​ ​ ​ ​
  
ARMASOAcetylcholine Receptor Modulating Antibody (0099521)careygej@mfldclin.org
YesNo
Fasting RequiredSpecimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​No​Serum​Serum Separator Tube (SST)​​0.5 mL​​0.3 mL
8.011/2/2022 9:40 AMdrexlerk@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
83516​​​1​Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative of semiquantitative, multiple step method.​
  
AFACESOAcetylcholinesterase, Amniotic Fluid (ACHE_)Potter, Joli K
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Amniotic fluid ​ Amniotic fluid container​ ​ 1 mL​ 0.3 mL​ ​
11.06/22/2022 1:54 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​82013 ​ ​ ​ ​
  
 ACHSSOAcetylcholinesterase, Erythrocytes (ACHS)Potter, Joli K
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Whole blood EDTA Lavender Top Tube (LTT)​ ​ 4 mL​ 2.5 mL​ ​
11.06/22/2022 1:58 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​82482 ​ ​ ​ ​
  
AFSTAcid Fast StainTheiler, Beth A
NoNo
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​
Any
(except blood and bone marrow)​
 Sterile, leakproof container (e.g. Sage container) ​ ESwab™, or other Amies medium based swab

5-10 mL​

1 swab, ESwab
1 mL fluids and secretions
0.5 g tissues
​		 ​
16.011/2/2022 9:57 AMdrexlerk@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
87206​ ​ ​ ​Fluorescent/acid fast stain ​
  
ACIDSOAcid Phosphatase, Prostatic (PACP)Wroblewski, Jennifer
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​1 mL ​0.4 mL ​
9.06/22/2022 1:21 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​84066 ​ ​ ​ ​
  
ACTHST2 ACTH Stimulation Test, 60 Min CortisolHebert, Lori M
NoNo
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​ Serum or Plasma​Serum Separator Tube (SST)​Red Top Tube (RTT)​, Lithium-heparin Plasma Separator Tube (PST), Sodium-heparin Green Top Tube (GTT)0.5 mL​0.3 mL​0.255 mL​
14.02/26/2020 10:00 AMpotterj@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
80400​ ​ ​ ​ ​
  
ACTHST3ACTH Stimulation, 30 and 60 Min CortisolsHebert, Lori M
NoNo
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​ Serum or Plasma​Serum Separator Tube (SST)Red Top Tube (RTT),Lithium-heparin Plasma Separator Tube (PST), Sodium-heparin Green Top Tube (GTT) 0.5 mL​0.3 mL​0.255 mL​
13.02/26/2020 9:56 AMpotterj@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
80400​ ​ ​ ACTH Stim Panel​ ​
82533​ ​ ​ Cortisol, total​ ​
  
APCRVSOActivated Protein C Resistance V, Plasma (APCRV)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Platelet-Poor Plasma​Citrated Light Blue Top Tube (BTT)​​1 mL​0.5 mL​
5.06/22/2022 1:29 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
85307​​​1​​
  
ACRNSOAcylcarnitines, Quantitative (ACRN)Potter, Joli K
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Plasma​ Sodium-heparin Green Top Tube (GTT)​ EDTA Lavender Top Tube (LTT) or Lithium Heparin Green Top Tube (GTT) ​ 0.1 mL​ 0.04 mL​ ​
15.06/23/2022 2:49 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​82017 ​ ​ ​ ​
  
AGU20SOAcylglycines, Quantitative, Random, Urine (AGU20)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Urine​Plastic, 10-mL urine tube​​10 mL​4 mL​If insufficient collection volume, submit as much as possible in a single container; the laboratory will determine if volume is sufficient for testing.
4.06/23/2022 2:56 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​82542​​1​​
  
ADALXSOAdalimumab Quantitative with Reflex to Antibody, Serum (ADALX)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Serum Separator Tube (SST)​Red Top Tube (RTT)​0.5 mL​0.35 mL​
5.06/23/2022 3:08 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​80145​​1​​
​83520​​1​​if needed
  
ADAMTSOADAMTS13 Evaluation (1295)januszj@mfldclin.org
NoNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Plasma​ (preferred) ​Citrated Blue Top Tube (BTT) ​ ​Three 0.5 mL aliquots ​Two 0.4 ml aliquots ​
​Serum ​​Red Top Tube (RTT) ​Three 0.5 mL aliquots ​Two 0.4 ml aliquots ​
​Whole Blood​​Light Blue Top Tube​​Three 0.5 mL aliquots​​Two 0.4 ml aliquots​
13.04/22/2021 1:29 PMdrexlerk@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
85397​ ​ ​1 ADAMTS13 Activity​ ​
​85335 ​ ​1 ADAMTS13 Inhibitor (if performed)​ ​
​83520 ​ ​1 ADAMTS13 Antibody (if performed)​ ​
  
ADAMT13ADAMTS13 Evaluation, RapidBarnes, Alyssa
NoNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Plasma​ Citrated Blue Top Tube (BTT)​ ​ Two 0.75 mL  aliquots​
Two 0.75 mL 
aliquots​
  0.5 mL​
11.03/21/2016 4:37 PMbusedj@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​85397 ​ ​ ​ ​
  
FADPFSOAdenosine Deaminase, Pleural Fluid (FADPF)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Pleural Fluid​Leak Proof Container​​0.5 mL​0.2 mL​
5.06/24/2022 9:57 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​84311​​1​​
  
ACTH-PAdrenocorticotropic Hormone (ACTH)Schalow, Dianne M
NoNo
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​ EDTA Pink Top Tube (PTT)-pre-chilled​ EDTA Lavender Top Tube (LTT)-pre-chilled​ 0.5 mL​ 0.5 mL​ 0.4 mL​
12.011/22/2022 1:00 PMchadwica@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
82024 ​ ​ ​ ​ ​
  
ALTAlanine Amino TransferasePotter, Joli K
NoNo
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 Lithium-heparin Plasma Separator (PST)​, Serum Separator Tube (SST) Lithium or Sodium-heparin Green Top (GTT), Red Top Tube (RTT) 1 mL​ 0.5 mL​ 0.6 mL whole blood​
17.011/18/2019 3:18 PMpotterj@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​84460 ​ ​ ​ ​
  
ALBAlbuminPotter, Joli K
NoNo
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

Lithium-heparin Plasma Separator Tube (PST), Serum Separator Tube (SST)

Lithium or Sodium-heparin Green Top Tube (GTT), Red Top Tube (RTT)​ 1 mL​ 0.5 mL​ 0.1 mL​
16.011/18/2019 3:16 PMpotterj@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
82040 ​ ​ ​ ​ ​
  
ALB-OAlbumin, Body FluidPotter, Joli K
NoNo
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 Body Fluid​
Syringe
 
No Additive Waste Tube​
 Sterile screw top container​ 2.0 mL​ 0.5 mL​ ​
12.02/20/2020 1:34 PMpotterj@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
82042 ​ ​ ​ ​ ​
  
ALCAlcohol, BloodPotter, Joli K
NoNo
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 ​Lithium-heparin Plasma Separator Tube (PST), Serum Separator Tube (SST)

Lithium or Sodium-heparin Green Top (GTT), Red Top (RTT)
Gray Top (GYTT)​

 0.5 mL​ 0.2 mL​ ​
20.01/4/2021 2:54 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
82077 ​ ​1 ​ ​
  
ALDOAldolasePotter, Joli K
NoNo
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 Serum​ Red Top Tube (RTT) ​ 1 mL​ 0.5 mL​ 0.6 mL whole blood
11.01/11/2022 1:06 PMchadwica@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
82085 ​ ​ ​ ​ ​
  
ALDOUSOAldosterone, 24 Hour, Urine (ALDU)Potter, Joli K
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume
Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Urine​ Plastic, 10-mL urine tube​ ​ 10 mL​ 1 mL​ ​
17.06/24/2022 10:16 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​82088 ​ ​ ​ ​
  
ALDSSOAldosterone, Serum (ALDS)Schalow, Dianne M
YesNo
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​ Serum​ Red Top Tube (RTT)​ ​Serum Separator Tube (SST) 1.2 mL​ 1.2 mL
16.06/30/2022 10:38 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
82088 ​ ​ ​ ​ ​
  
ALDSSOTESTAldosterone, Serum (ALDS) Testpotterj@mfldclin.org
NoNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​1.2 mL ​0.6 mL ​
2.01/20/2021 9:50 AMdrexlerk@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​82088 ​ ​ ​ ​
  
ALKRESOALK (2p23) Rearrangement, FISH, Tissue (LCAF)potterj@mfldclin.org
YesNo
​
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
​​(no repeat)
Tissue
FFPE
tumor tissue block
 Slides 4 consecutive, unstained, 5 micron thick sections placed on positively charged slides and 1 H&E slide 3 consecutive, unstained, 5 micron thick sections placed on positively charged slides and 1 H&E slide ​
22.06/22/2022 1:50 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​88291 ​ 1 Interpretation and report​ ​​​
​88271​ ​ 2 ​​Probe Set, 1ST
88271​​ ​ 2 Probe, +2 ​​​as needed
88271​​ ​ ​1 ​Probe, +1 ​​​as needed
​88271​ ​ ​2 ​​Probe, +2 ​​​as needed
88271​​ ​ ​3 ​​Probe, +3 ​​​as needed
​88274​ ​ ​1 ​Interphases, <25​ ​​​as needed
​88274​ ​ ​1 ​Interphases, 25-99 ​​​as needed
​88275 ​ ​1 ​Interphases, >100 ​​​as needed
  
ALKPAlkaline Phosphatase, TotalPotter, Joli K
NoNo
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 Lithium -heparin Plasma Separator (PST)​, Serum Separator Tube (SST)
Lithium or Sodium-heparin Green Top (GTT), Red Top (RTT)
 
 1 mL​ 0.5 mL​ 0.5 mL whole blood​
18.011/18/2019 3:18 PMpotterj@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
84075 ​ ​ ​ ​ ​
  
ALKISOAlkaline Phosphatase, Total and Isoenzymes, Serum (ALKI)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​1 mL (divided into 2 tubes, each containing 0.5 mL) ​0.5 mL (divided into 2 tubes, each containing 0.25 mL) ​
5.06/30/2022 11:46 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​84080 ​ ​1 ​Isoenzymes ​
​84075 ​ ​1 ​Alkaline Phosphatase ​
  
ALANSSOAllergen IgE, Anise  (ANSE)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL ​0.3 mL ​
4.07/11/2022 3:11 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALASCSOAllergen IgE, Ascaris (ASCRI)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for each 5 allergens requested For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace​		 ​
3.07/11/2022 3:17 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALBROSOAllergen IgE, Broccoli (BROC)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL ​0.3 mL ​
3.07/11/2022 3:29 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALBFTSOAllergen IgE, Budgerigar Feathers (BFTH)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.3 mL ​ ​
4.07/11/2022 3:40 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALCHLSOAllergen IgE, Chili Pepper (CHILI)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested ​0.3 mL ​
3.07/11/2022 3:49 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALCOWSOAllergen IgE, Cow Epithelium (COW)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.3 mL ​ ​
3.07/12/2022 9:32 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALFEESOAllergen IgE, Ferret Epithelium (FEEP)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL ​0.3 mL ​
4.07/12/2022 10:39 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
FDP1SOAllergen IgE, Food Panel #2, Serum (FDP1)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL​0.3 mL​
2.02/2/2022 1:50 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALGSTSOAllergen IgE, Green String Bean (GSTB)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.3 mL ​ ​
3.07/12/2022 10:48 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALGUISOAllergen IgE, Guinea Pig Epithelium (GUIN)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.3 mL ​ ​
3.07/12/2022 10:58 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
FCGUMSOAllergen IgE, Gum Carageenan IgE (FCGUM)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL​0.5 mL​
1.02/4/2022 4:00 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALHORSOAllergen IgE,  Horse Dander (HORS)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.3 mL ​ ​
3.06/30/2022 11:55 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
ALLETSOAllergen IgE, Lettuce (LETT)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL ​0.3 mL ​
4.07/12/2022 11:10 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
PCANHSOAllergen IgE, Pecan Hickory, IgE, Serum (PCANH)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
1.02/8/2022 11:03 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALPNASOAllergen IgE, Pineapple (PNAP)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) Serum Separator Tube (SST) ​0.5 mL ​0.3 mL ​
3.07/12/2022 4:14 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​1 ​ ​
  
SQUASOAllergen IgE, Squash, Serum (SQUA)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
2.02/9/2022 11:41 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
WHEYSOAllergen IgE, Whey, Serum (WHEY)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 for every 5 allergens requested​0.3 mL​
2.02/2/2022 1:06 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALBENSOAllergen IgE, White Bean (BENW)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL ​0.3 mL ​
5.07/13/2022 11:41 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments

86003

 ​ ​1 ​ ​
  
WILLSOAllergen IgE, Willow, Serum (WILL)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
1.02/2/2022 1:18 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALJOHSOAllergen Johnson Grass, IgE (JOHN)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ ​Serum Separator Tube (SST) ​0.5 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/13/2022 11:49 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALFODSOAllergen Panel, Food (FOOD6)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL
0.3 mL
 ​
11.07/13/2022 1:03 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
APGALSOAllergen Panel, Galactose-Alpha-1, 3-Galactose (Alpha-Gal) Mammalian Meat Allergy Profile, Serum (APGAL)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​1.5 mL​​
3.07/13/2022 1:16 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​5​​
  
ALHDUSOAllergen Panel, House Dust (HD1)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator tube (SST) ​0.7 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/13/2022 1:24 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALMOLDAllergen Panel, Mold (MOLD1)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
8.07/13/2022 1:31 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALNT1SOAllergen Panel, Nut #1 (FOOD8)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top tube (RTT) ​Serum Separator Tube  (SST) 0.5 mL​
0.3 mL
 ​
7.07/13/2022 2:55 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALPED1Allergen Panel, Ped <3 Years (PAS3)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.7 mL for every 5 allergens requested
For 1 allergen: 0.5 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace
 ​
8.07/13/2022 3:13 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ 5​ ​Allergen specific IgE ​
  
ALPED3Allergen Panel, Ped >8 Years (PAS8)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.7 mL for every 5 allergens requested
For 1 allergen: 0.5 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/19/2022 11:29 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​5 ​Allergen specific IgE ​
  
ALPED2Allergen Panel, Ped 3-8 Years (PAS38)Janusz, Janice M
YesNohttps://testreference.marshfieldlabs.org/sites/ltrm/Human/Search/SitePages/results.aspx?k=PrimarySendoutID:354&s=Human
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) 0.8 mL for every 5 allergens requested For 1 allergen: 0.6 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace		 ​
7.07/13/2022 3:04 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ 6​ Allergen specific IgE​ ​
  
ALRP8SOAllergen Panel, Respiratory Midwest (RPR8)wroblewj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​2 mL ​1.55 mL ​
3.07/19/2022 11:36 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​82785 ​ ​1 ​IgE ​
​86003 ​ ​25 ​Each indivual allergen ​
  
MRASTAllergen Panel, Stinging Insects-5 Allergens (INSEC)Potter, Joli K
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Serum Red Top Tube (RTT)​ ​Serum Separator Tube (SST) ​0.8 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space​
 ​
8.07/19/2022 11:44 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ 5​ ​ ​
  
ALTRESOAllergen Panel, Tree #1 (TREE1)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL
0.3 mL
 ​
8.07/19/2022 11:51 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALPSISOAllergen Pistachio, IgE (PISTA)januszj@mfldclin.org
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/19/2022 12:00 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​ ​ ​
  
ALALFSOAllergen, Alfalfa (Medicago sativa) IgE (FALPE)knoxa@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL​0.5 mL​
3.07/19/2022 1:09 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALAMSOAllergen, Almond, IgE (ALM)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/19/2022 1:16 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALAMYSOAllergen, Alpha-Amylase, IgE (AAMY)pionkowd@mfldclin.org
YesNo
Fasting RequiredSpecimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​No​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
4.07/19/2022 1:22 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86008​​1​​
  
ALALBSOAllergen, Alpha-Lactalbumin, IgE (ALFA)pionkowd@mfldclin.org
YesNo
Fasting RequiredSpecimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​No​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
6.07/19/2022 3:14 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86008​​1​​
  
ALTERSOAllergen, Alternaria tenuis, IgE (ALTN)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) 0.5 mL​ for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/19/2022 3:24 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALAMXSOAllergen, Amoxicillin, IgE (AMOXY)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL​0.3 mL​
3.07/20/2022 11:45 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALANCSOAllergen, Anchovy, IgE (ANCH)potterj@mfldclin.org
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested ​0.3 mL for 1 allergen; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space ​
3.07/20/2022 11:55 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​​ ​ ​1 ​Anchovy, IgE ​
  
ALAPPSOAllergen, Apple, IgE (APPL)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
10.07/20/2022 12:00 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALFUMSOAllergen, Aspergillus fumigatus, IgE (ASP)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) 0.5 mL​ for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/21/2022 11:03 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALAVOSOAllergen, Avocado, IgE (AVOC)potterj@mfldclin.org
YesNo
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 ​Serum ​Red Top Tube (RTT) ​Serum Separator Tube (SST) 0.5 mL for every 5 allergens requested

For 1 allergen:  ​0.3 mL​

For more than 1 allergen: (0.05 mL x number of allergens) = 0.25 mL dead space.
3.07/21/2022 11:13 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​​ ​ ​1 ​
  
ALBAKSOAllergen, Bakers Yeast, IgE (BYST)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ Red Top Tube (RTT)​ ​Serum Separator Tube (SST) 0.5 mL ​for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/21/2022 11:20 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALBMBSOAllergen, Bamboo Shoot, IgE, Serum (BAMB)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube​0.5 mL for every 5 allergens requested​0.3 mL​
4.07/21/2022 11:27 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALBANSOAllergen, Banana, IgE (BANA)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.07/21/2022 11:33 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALBRLSOAllergen, Barley, IgE, Serum (BRLY)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3​
5.07/21/2022 11:51 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALBASSOAllergen, Bass, Black, IgE (43310)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Serum ​Red Top Tube (RTT) ​ 0.5 mL 340 uL ​
8.04/16/2021 1:05 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​ ​ ​
  
ALBEFSOAllergen, Beef, IgE (BEEF)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for each 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.08/16/2022 10:09 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALBERSOAllergen, Bermuda Grass, IgE (BERG)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.08/16/2022 10:20 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​1 ​ ​
  
ALBLCSOAllergen, Beta-Lactoglobulin, IgE (BLAC)pionkowd@mfldclin.org
YesNo
Fasting RequiredSpecimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​No​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
4.08/16/2022 10:28 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86008​​1​​
  
ALBBSOAllergen, Black Bean, IgE (34410E)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Serum ​Red Top Tube (RTT) ​ 0.5 mL ​340 uL ​
8.04/19/2021 1:11 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
​86003 ​ ​ ​ ​
  
ALBLPSOAllergen, Black/White Pepper, IgE, Serum (BLPEP)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
3.08/16/2022 10:41 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALMSSSOAllergen, Blue Mussel, IgE (MUSS)pionkowd@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (STT)​0.5 mL for every 5 allergens requesed​0.3 mL​
4.08/16/2022 11:07 AMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALBLUSOAllergen, Blueberry, IgE (BLUE)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
8.08/16/2022 11:01 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALBOXSOAllergen, Box Elder/Maple, IgE (BXMPL)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
8.08/16/2022 11:15 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALBRZSOAllergen, Brazil Nut, IgE (BRAZ)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.08/16/2022 1:20 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALBUCSOAllergen, Buckwheat, IgE (BUCW)knoxa@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
3.08/16/2022 1:25 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALBDRSOAllergen, Budgerigar Droppings, IgE, Serum (BDRP)knoxa@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
3.08/16/2022 1:32 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALCACSOAllergen, Cacao/Cocoa, IgE (COCOA)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.08/26/2022 9:37 AMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
  
ALCFTSOAllergen, Canary Feathers, IgE, Serum (CFTH)knoxa@mfldclin.org
YesNo
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)		Pediatric Minimum Volume
(no repeat)
​Serum​Red Top Tube (RTT)​Serum Separator Tube (SST)​0.5 mL for every 5 allergens requested​0.3 mL​
4.09/1/2022 2:54 PMpionkowd@mfldclin.org
CPTModifier
(if needed)		QuantityDescriptionComments
​86003​​1​​
  
ALCANSOAllergen, Candida albicans, IgE (CDAB)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top Tube (RTT) ​Serum Separator Tube (SST) 0.5 mL​ for every 5 allergens requested
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
7.09/1/2022 12:18 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003 ​ ​ ​ ​
  
ALCRTSOAllergen, Carrot, IgE (CROT)Janusz, Janice M
YesNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Serum​ ​Red Top tube (RTT) ​Serum Separator Tube (SST) ​0.5 mL for every 5 allergens ordered
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
 ​
8.09/1/2022 12:25 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)		 Quantity Description Comments
86003​ ​ ​ ​ ​
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