Skip Ribbon Commands
Skip to main content
Sign In

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

  
  
  
  
  
  
  
  
  
  
Specimen Requirements
  
  
  
CPT Codes
  
A1ALCSO Alpha-1-Antitrypsin Proteotype S/Z by LC-MS/MS, Serum (A1ALC)wroblewj@mfldclin.orgknechta@mfldclin.orgYesNo
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
1.012/4/2017 9:12 AMwroblewj@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
4.04/17/2019 8:02 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​88271 ​2 ​DNA probe, each (first probe set)
​88291 ​1 ​Interpretation and Report
​88271 ​2 ​DNA probe, each; each additional probe ​if appropriate
​88271 ​1 ​DNA probe, each; coverage for sets containing 3 probes ​if appropriate
​88271 ​2 ​DNA probe, each; coverage for sets containing 4 probes ​if appropriate
​88271 ​3 ​DNA probe, each; coverage for sets containing 5 probes ​if apporpriate
​88274 ​52 ​1 ​Interphase in situ hybridization, <25 cells, each probe set ​if appropriate
​88274 ​1 ​Interphase in situ hybridization, 25 to 99 cells, each probe set ​if appropriate
​88275 ​1 ​Interphase in situ hybridization, 100 to 300 cells, each probe set ​if appropriate
​88361 ​1 ​HER Breast IHC Automated No Reflex ​if appropriate
​88360 ​1 ​HER Breast Semi Quant IHC Manual ​if appropriate
  
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
1.09/18/2017 10:35 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​84143 ​1
  
17HPSO17-Hydroxyprogesterone (OHPG)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)​ 0.6 mL​ 0.25 mL​
5.011/11/2016 2:13 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​83498
  
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 ​​Formalin fixed Paraffin block and 1 H&E stained slide
4.06/6/2019 1:26 PMbusedj@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
  
23BPGSO2,3-Dinor-11Beta-Prostaglandin F2 Alpha, Urine (23BPG)pionkowd@mfldclin.org
YesNo
​Submit only 1 of the following specimens:  ​ ​
Specimen TypePreferred Container/TubeAcceptable Container/TubeSpecimen VolumeSpecimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Urine, 24-hour24-hour Urine Jug​4 mL​3 mL
Urine, Random​Sterile Container​4 mL​3 mL
4.05/15/2020 11:48 AMpionkowd@mfldclin.org
CPTModifier
(if needed)
QuantityDescriptionComments
​84150​1
  
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​
12.01/22/2020 4:28 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
2.02/18/2020 11:38 AMknoxa@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 ​10 mL Urine Tube ​Plastic Urine Container ​10 mL ​5 mL ​1 mL
1.04/24/2018 12:27 PMwroblewj@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​
18.05/21/2020 1:25 PMknoxa@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​
24.06/25/2020 3:45 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
80307 ​
  
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 Comments
​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​
13.010/10/2018 1:03 PMbusedj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​83519
  
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​
7.011/14/2016 10:48 AMpotterj@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​
7.011/14/2016 10:50 AMpotterj@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
14.02/27/2018 8:35 AMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
87206​ ​Fluorescent/acid fast stain
  
LADLSOAcid Lipase Levelpionkowd@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 ​Whole Blood ​5 full blood circles of EDTA Lavender Top Tube (LTT) whole blood on specimen collection card ​3 full blood circles on specimen collection card
​No ​Whole Blood ​EDTA Lavender Top Tube (LTT) or Sodium Heparin Green Top Tube (GTT) ​2 mL ​2 mL
3.09/14/2015 12:46 PMbusedj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​82657
  
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
5.011/14/2016 10:54 AMpotterj@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
1.06/18/2020 3:02 PMpionkowd@mfldclin.org
CPTModifier
(if needed)
QuantityDescriptionComments
85307​​1
  
AMLFSOAcute Myeloid Leukemia (AML), FISH (AMLF)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)
​Submit only 1 of the following specimens: ​ ​ ​ ​ ​ ​
​No ​Whole Blood ​Sodium-Heparin Green Top Tube (GTT) ​10 mL ​2 mL
​No ​Bone Marrow ​Sodium-Heparin Green Top Tube (GTT) ​2 mL ​1 mL
3.010/20/2017 4:09 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​88291 ​1 ​Cyto/Molecular Report
​88271 ​2 ​Cytogenetics DNA Probe
​88271 ​Additional probes may be added at additional fees ​As needed
  
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​ 0.1 mL​ 0.04 mL​
13.08/21/2019 3:30 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​82017
  
ACYLGSOAcylglycines, Quantitative, Urine (ACYLG)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 ​Random Urine (no preservative) ​Plastic tube ​10 mL ​4 mL
2.07/21/2017 7:21 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​82542
  
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
2.06/10/2020 3:22 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​ ​Citrated Blue Top Tube (BTT) ​Three 0.5 mL aliquots ​Two 0.4 ml aliquots
OR​ ​ ​ ​ ​ ​
​Serum ​Red Top Tube ​Three 0.5 mL aliquots ​Two 0.4 ml aliquots
8.011/14/2016 11:12 AMpotterj@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
  
FADPLSOAdenosine Deaminase, Pleural Fluid (FADPL)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 ​Pleural Fluid ​Leak Proof Container ​0.3 mL ​0.1 mL
1.011/21/2017 8:06 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​84311 ​1
  
MISCAdenovirus Antibodies IgG and IgM, Serum (FADV)Potter, Joli K
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)​ Serum Separator Tube (SST)​ 1 mL​ 0.5 mL​
8.08/1/2018 4:42 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​86603
  
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​
11.01/23/2020 9:03 AMpotterj@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​
19.06/25/2020 3:47 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
80307
  
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​ Serum Separator Tube (SST) ​Red Top (RTT)​ 1 mL​ 0.5 mL​ 0.6 mL whole blood
10.02/20/2020 1:34 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
82085 ​
  
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​ 0.6 mL​
12.01/22/2019 3:19 PMpionkowd@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
82088 ​
  
ALDSSOTESTAldosterone, Serum (ALDS) Testpotterj@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) ​1.2 mL ​0.6 mL
1.06/13/2019 1:48 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​82088
  
ALDOUSOAldosterone, 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​ 6mL​
10.011/14/2016 11:52 AMpotterj@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
Tumor adequacy is optimally at least ​300 tumor cells for FISH testing, 50 cells is required.  Less than 50 cells will be cancelled. ​ ​ ​ ​ ​
17.04/26/2017 2:26 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
  
MISCAlkaline Phosphatase, Bone Specific (513002)Potter, Joli K
NoNo
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
Serum​ Serum Separator Tube (SST)​ 1.0 mL​ 0.5 mL​
9.09/17/2015 8:47 AMbusedj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments

​84080

  
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) ​0.5 mL (divided into 2 tubes)
3.011/8/2019 4:06 PMknoxa@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​84080 ​1 ​Isoenzymes
​84075 ​1 ​Alkaline Phosphatase
  
ALLSOAllergen IgE Antibodies, Single Allergen, Serumjanuszj@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)​ ​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
3.011/14/2016 2:30 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​86003
  
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
1.04/24/2018 7:54 AMwroblewj@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 dead space
1.03/21/2018 11:51 AMwroblewj@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
1.04/24/2018 8:08 AMwroblewj@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
2.03/21/2018 11:58 AMwroblewj@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) ​0.3 mL
1.03/21/2018 12:06 PMwroblewj@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
1.03/21/2018 12:12 PMwroblewj@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
1.04/24/2018 8:15 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​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
1.03/21/2018 12:18 PMwroblewj@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
1.03/21/2018 12:24 PMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​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
1.03/21/2018 12:31 PMwroblewj@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
1.04/24/2018 8:25 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​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
1.012/18/2017 9:08 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
​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
1.04/24/2018 7:59 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments

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
5.011/14/2016 2:32 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86003​
  
ALAGPSOAllergen Panel, Alpha-Gal (FAGPL)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)​2 mL​1 mL
3.01/10/2020 10:50 AMdrexlerk@mfldclin.org
CPTModifier
(if needed)
QuantityDescriptionComments
​86003​3
​86008​1
  
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
For 1 allergen: 0.3 mL/For more than 1 allergen: 0.05 mL x number of allergens + 0.25 mL dead space
7.011/14/2016 2:34 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86003​
  
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) ​0.5 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/14/2016 2:44 PMpotterj@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 (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
6.011/14/2016 2:47 PMpotterj@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​
For 1 allergen: 0.3 mL/For more than 1 allergen: 0.05 mL x number of allergens + 0.25 mL dead space
5.011/14/2016 2:49 PMpotterj@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) ​0.5 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
6.011/14/2016 2:51 PMpotterj@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) ​0.5 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:08 PMpotterj@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) ​0.6 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
4.011/11/2013 1:52 PMSystem Account
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
1.011/1/2017 11:58 AMwroblewj@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) ​0.5 mL
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space​
6.011/16/2016 2:13 PMpotterj@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
For 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:17 PMpotterj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:22 PMpotterj@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​0.3 mL
1.07/1/2020 4:45 PMknoxa@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:24 PMpotterj@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​0.3 mL
2.01/9/2020 3:25 PMpionkowd@mfldclin.org
CPTModifier
(if needed)
QuantityDescriptionComments
​86008​1
  
ALALBSOAllergen, Alpha-Lactoalbumin, 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​0.3 mL
3.01/9/2020 3:41 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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:25 PMpotterj@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
1.06/10/2020 1:03 PMpionkowd@mfldclin.org
CPTModifier
(if needed)
QuantityDescriptionComments
​86003​1
  
ALANCSOAllergen, Anchovy, IgE (ANCH)potterj@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) ​Serum Separator Tube (SST) ​0.5 mL ​0.3 mL For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
1.07/17/2017 9:05 AMpotterj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
8.011/16/2016 2:27 PMpotterj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:29 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86003​
  
ALAVOSOAllergen, Avocado, IgE (AVOC)potterj@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) ​1.0 mL

​0.3 mL​

For more than 1 allergen: (0.05 mL x number of allergens) = 0.25 mL dead space.

1.07/17/2017 9:09 AMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86003​​ ​1 ​Allergen specific IgE quan/semiquan each allergen
  
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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:31 PMpotterj@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​0.3 mL
2.06/10/2020 3:18 PMpionkowd@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:33 PMpotterj@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​0.3
2.06/10/2020 12:35 PMpionkowd@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) ​1 mL for each 5 allergens submitted ​0.3 mL
7.012/5/2016 8:45 AMwroblewj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:39 PMpotterj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 2:53 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86003​
  
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​0.3 mL
1.01/9/2020 3:39 PMpionkowd@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) ​1 mL for each 5 allergens submitted ​0.5 mL
7.012/5/2016 8:45 AMwroblewj@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​0.3 mL
1.06/10/2020 12:48 PMpionkowd@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​0.3 mL
2.06/18/2020 3:27 PMpionkowd@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
6.011/16/2016 3:26 PMpotterj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 3:28 PMpotterj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 3:31 PMpotterj@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​0.3 mL
1.07/1/2020 4:24 PMknoxa@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​0.3 mL
1.06/17/2020 10:08 AMknoxa@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 3:33 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86003​
  
ALCSNSOAllergen, Caesin, IgE (CASE)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
6.01/2/2018 8:50 AMwroblewj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86008
  
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​0.3 mL
1.07/1/2020 4:11 PMknoxa@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 3:36 PMpotterj@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 1 allergen: 0.3 mL/For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space
5.011/16/2016 3:37 PMpotterj@mfldclin.org
CPT Modifier
(if needed)
Quantity Description Comments
86003​
1 - 100Next