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a-1-Antitrypsin, Proteotype
A1A Proteotyping
AAT Proteotyping
Alpha 1 Antitrypsin
Alpha-1-Antitrypsin by MS
Anti-Alpha-1-Trypsin
Antitrypsin
Antitrypsin, Proteotyping
Pi Typing (Alpha-1-Antitrypsin Proteotyping)
Protease Inhibitor Allo Typing

12/4/2017 9:03 AM

6/22/2022 9:20 AM

pionkowd@mfldclin.org

26079

HER2FSO

HER2 Amp, Breast Cancer, FISH, Tissue (H2BR)

14798

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
88377		1
88361		1	HER Breast IHC Automated No Reflex	if appropriate

Breast Carcinoma

c-erb-b2 Amplification Test (FISH)

TI HER2FSO

4/9/2018 10:23 AM

6/22/2022 9:42 AM

pionkowd@mfldclin.org

Submit a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block.

Four consecutive, unstained, 5 micron-thick sections placed on positively charged slides, and 1 hematoxylin and eosin-stained slide.

1. A pathology report is required in order for testing to be performed. Acceptable pathology reports include working drafts, preliminary pathology or surgical pathology reports.

2. A reason for testing must be provided. If this information is not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.

3. The pathology report must include type and time of fixation, as well as the cold ischemia time.

Note: In accordance to CAP guidelines, place specimens for HER2 (ERBB2) testing in fixative within one hour of biopsy or resection (cold ischemia time). Specimens should remain in 10% neutral buffered formalin for a minimum of six hours to a maximum of 72 hours (formalin fixation time). Do not use decalcification solutions with strong acids.(2)

26823

RMPUSO

Monoclonal Protein Studies, Random, Urine

15575

Yes

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	Urine container, 60 mL (T313)	60 mL urine bottle	50 mL	30 mL	30 mL

Mass-Fix, Mass Fix, MassFix, Bence Jones Urine, Heavy Chains Urine, Immunoelectrophoresis, Immunofixation Electrophoresis (IFE), Immunofixation, Kappa Chains Urine, Lambda Chains Urine, Light Chains Urine, Paraprotein, Special Protein Studies, M-protein

8/21/2025 12:22 PM

8/21/2025 3:00 PM

drexlerk@mfldclin.org

This test was developed and its performance characteristics determined by Marshfield Labs. It has not been cleared or approved by the US Food and Drug Administration. This test is used for clinical purposes. It should not be regarded as investigational or for research.

Refrigerate specimen during collection and send refrigerated

Aliquot between 30 and 50 mL of urine into a plastic, 60 mL urine bottle

26638

SSCTUSO

S-Sulfocysteine Panel, Urine (SSCTU)

15388

Yes

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
Urine	Urine Tube, 10 mL (T068)	Plastic, 10 mL urine tube	3 mL	2 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
82542		1	Column chromatography, non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen

Hypoxanthine, S-Sulfocysteine, Uric Acid, Xanthine, Hereditary xanthinuria, Isolated sulfite oxidase deficiency, Lesch-Nyhan syndrome, Molybdenum cofactor deficiency, Xanthine dehydrogenase and xanthine aldehyde oxidase dual deficiency, Xanthine dehydrogenase deficiency, Xanthine dehydrogenase/xanthine aldehyde oxidase/sulfite oxidase combined deficiency

11/13/2024 11:38 AM

11/13/2024 12:09 PM

drexlerk@mfldclin.org

Collect a random urine specimen.

26654

USCSSO

Unity Screen Carrier Screen with Reflex sgNIPT

15405

Yes

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
Whole Blood	3- Streck 10 mL	N/A	30 mL total: 10 mL in each of 3 DNA Streck tubes (30 mL total)	10 mL	N/A

CPT	Quantity	Description
81220	1	Cystic Fibrosis
81329	1	Spinal Muscle Atrophy
81361	1	β-Thalassemia (HBB)
81257	1	Alpha Thalassemia (HBA)
81243	Optional	Fragile X

4/7/2025 11:39 AM

7/22/2025 1:00 PM

winterhj@mfldclin.org

26802

BLOD1206

1,3-Beta-D-Glucan (Fungitell), Serum (BLOD1206)

15554

Yes

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)		1.0 mL	0.5 mL	0.5 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
87449

Fungitell, Fungal Antigen, Candida Antigen, BDG

8/19/2025 2:23 PM

8/19/2025 2:28 PM

beltermk@mfldclin.org

DO NOT ALIQUOT BLOOD SPECIMENS, send centrifuged serum gel tube refrigerated in original container. Pouring off these specimens leads to the potential for environmental contamination of the sample that can lead to false positive results. Specimen cannot be shared. Centrifuge specimen within 2 hours of collection.

Specimens are forwarded to appropriate testing lab by Sanford- Sioux Falls laboratory.

26420

DCORTSO

11-Deoxycortisol, Serum (DCORT)

15169

Yes

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	0.4 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
82634		1

11-Deoxycortisol, 11-Deoxycorticosteroid, Cortodoxone, INN, USAN, BAN, 11-Desoxycortisol, 17-hydroxy-11-deoxycorticosterone, Compound B, Compound S, Corticosterone, Deoxycortisol, Tetrahydro S, Cortoxelone

2/11/2022 12:02 PM

2/11/2022 12:11 PM

pionkowd@mfldclin.org

Indicate if specimen was drawn before or after metyrapone.

Morning (8 a.m.) specimen is preferred.

26027

17OHPSO

17-Hydroxypregnenolone, Serum (17OHP)

14748

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
84143		1

17-Hydroxypregnenolone

9/18/2017 10:30 AM

11/30/2023 9:27 AM

drexlerk@mfldclin.org

Centrifuge and aliquot serum into plastic vial.

26559

17HPSO

17-Hydroxyprogesterone, Serum

15308

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
83498		1

17 Alphahydroxyprogesterone; 17 Hydroxy Progesterone, Serum; Hydroxyprogesterone; Progesterone, 17-Hydryoxy

7/10/2023 2:15 PM

7/11/2023 9:24 AM

chadwica@mfldclin.org

Necessary Information: Patient's age and sex are required.

26000

FGLIOSO

1p19q Deletion in Gliomas, FISH, Tissue (GLIOF)

14704

Yes

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

CPT	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

Oligodendroglioma

5/1/2017 9:47 AM

6/22/2022 1:40 PM

pionkowd@mfldclin.org

Submit a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block. Blocks prepared with alternative fixation methods may be acceptable; provide fixation method used.

Six consecutive, unstained, 5 micron-thick sections placed on positively charged slides, and 1 hematoxylin and eosin-stained slide.

A reason for referral and pathology report are required in order for testing to be performed. Send information with specimen. Acceptable pathology reports include working drafts, preliminary pathology or surgical pathology reports.

26649

23BPRSO

2,3-Dinor 11 Beta-Prostaglandin F2 Alpha, Random, Urine (23BPR)

15399

Yes

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
Random Urine	Sarstedt Aliquot Tube, 5 mL (T914)		5 mL	3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
82570		1
84150		1

11 Beta-Prostaglandin F2 Alpha; 11BPG; 2,3 11 Beta-Prostaglandin F2 Alpha; 23BPG; BPG2; Mastocytosis; Prostaglandin

3/19/2025 3:45 PM

3/19/2025 3:59 PM

chadwica@mfldclin.org

Patient Preparation: Patients taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may have decreased concentrations of prostaglandin F2 alpha. If medically feasible, for 2 weeks before specimen collection, patient should not take aspirin and for 72 hours before specimen collection, patient should not take NSAIDs.

23209

21HDRSO

21-Hydroxylase Ab, S (21OH)

13472

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
83516

21 Hydroxylase Antibody, 21-OH Ab, Adrenal Antibody, Hydroxylase Antibody, Anti-Adrenal Antibody, Addison's Disease

4/3/2013 2:54 PM

6/22/2022 1:42 PM

pionkowd@mfldclin.org

Centrifuge and aliquot serum into plastic vial to remove from cells or gel prior to shipping.

Ship serum specimen frozen

26096

HIAASO

5-Hydroxyindoleacetic Acid 24 Hr U (HIAA)

14815

Yes

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.

CPT	Modifier (if needed)	Quantity	Description	Comments
83497		1

5-HIAA (5-Hydroxyindolacetic Acid)
5-OH-Indoleacetic Acid
Carcinoid Syndrome
HIAA (Hydroxyindoleacetic Acid)
Serotonin Metabolite

5-Hydroxyindoleacetic Acid 24 Hr U (HIAA)

24 HIAASO

4/24/2018 12:14 PM

11/3/2025 1:38 PM

chadwica@mfldclin.org

This test was developed and its performance characteristics determined by Mayo Medical Laboratories.

*Intake of food with a high content of serotonin (avocados, dates, eggplant, all fruit [including bananas, cantaloupe, grapefruit, kiwifruit, melons, pineapple, plantains, plums], all nuts [including hickory nuts, butternuts, pecans, walnuts], and tomatoes and tomato products) within 48 hours of the urine collection could result in falsely elevated 5-hydroxyindoleacetic acid (5-HIAA) excretion.

1. Some medications could interfere with test results. The ordering provider should decide if any medications should be stopped and when they should be restarted. If clinically feasible, discontinue the following medications at least 48 hours prior to, as well as during, specimen collection:

-Acetaminophen (Tylenol or generic versions)

-Tryptophan containing supplements

2. For 48 hours prior to, as well as during, the urine collection, the patient should:

Limit the following to one serving per day:

-Fruits

-Vegetables

-Nuts

-Caffeinated beverages or foods

Collection Processing Instructions:
1. Collect a 24-hour urine specimen.
2. 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.

3. See Mayo Labs website for additional information regarding acceptable preservatives and collection details.

25146

HEROIN

6-Monoacetylmorphine (Heroin Metabolite), Urine

14300

Yes

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

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

6-MAM, 6-AM, Heroin

4/3/2013 3:04 PM

10/27/2022 4:16 PM

careygej@mfldclin.org

22153

ACETA

Acetaminophen

11804

Yes

Fasting Required

Specimen Type

Preferred Container/Tube

Acceptable Container/Tube

Specimen Volume

Specimen Minimum Volume
(allows for 1 repeat)

Pediatric Minimum Volume
(no repeat)

Plasma/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

CPT	Modifier (if needed)	Quantity	Description	Comments
80143		1

Datril, Tylenol

4/3/2013 2:31 PM

1/16/2025 2:28 PM

drexlerk@mfldclin.org

Serum/Plasma must be separated from cells within 2 hours of collection.

25462

MISC

Acetoacetate, Serum/Plasma (0060SP)

14603

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82010

Acetoacetic Acid

11/20/2014 8:48 AM

2/25/2020 12:54 PM

drexlerk@mfldclin.org

Promptly centrifuge and separate serum or plasma into a plastic screw capped vial using approved guidelines AND FREEZE (preferably at -70 C). Ship overnight Monday through Thursday, to arrive at NMS the following day.

22156

ACRB

Acetylcholine Receptor (Muscle AChR) Binding Antibody (ARBI)

11808

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86041

Acetylcholine Receptor (Muscle AChR) Antibodies, AChR (Acetylcholine Receptor), Anti -Neuromuscular Junction Receptor Antibodies, Myasthenia Gravis Antibodies, Acetylcholine Receptor Binding Antibody

4/3/2013 2:31 PM

12/29/2023 10:57 AM

chadwica@mfldclin.org

This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held for 1 week and assayed if sufficiently decayed or canceled if radioactivity remains.

For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication.

26383

ARMASO

Acetylcholine Receptor Modulating Antibody (0099521)

15132

Yes

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)		0.5 mL		0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86043		1

Acetylcholine Receptor Modulating Antibodies (0099521)

AChR Antibody

ACHR modulating antibody

Muscle nicotinic Acetylcholine Receptor (AChR) Modulating Antibody

Myasthenia Gravis Antibodies

2/3/2022 2:15 PM

12/29/2023 11:11 AM

chadwica@mfldclin.org

23213

AFACESO

Acetylcholinesterase, Amniotic Fluid (ACHE_)

13474

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82013

AChE-AF (Acetylcholinesterase, Amniotic Fluid), Amniotic Fluid, Acetylcholinesterase

4/3/2013 2:54 PM

6/22/2022 1:54 PM

pionkowd@mfldclin.org

1. A specimen from the 14 to 18 week gestational period of pregnancy is preferred. Amniotic fluid from the 14 to 21 week gestational period is acceptable.

Additional Information:

1. Gestational age at amniocentesis is required.

2. If chromosome studies are also requested, see CHRAF / Chromosome Analysis, Amniotic Fluid for specimen requirements. When requested with chromosome analysis, the specimen cannot be frozen.

Forms:

1. Second Trimester Maternal Screening Alpha-Fetoprotein (AFP)/QUAD Screen Patient Information Sheet is required; see Special Instructions

25066

ACIDSO

Acid Phosphatase, Prostatic (PACP)

14196

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
84066

Acid Phosphatase, Prostatic Isoenzyme, ELISA, PAP, Prostatic Acid Phosphatase, Phosphatase

4/3/2013 3:03 PM

5/15/2025 1:25 PM

drexlerk@mfldclin.org

Patient Preparation: For 12 hours before specimen collection, do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.

22164

ACTH Stimulation Test, 60 Min Cortisol

11814

Yes

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)	Lithium Heparin Green Top Tube (GTT), EDTA Lavender Top Tube (LTT), Serum Separator Tube (SST), Red Top Tube (RTT)	0.5 mL	0.4 mL	0.3 mL

GTT/RTT - physically separate plasma or serum from contact with cells as soon as possible of before transport. Separate from cells within 30 minutes to minimize uptake of corticosteroids by RBCs

CPT	Modifier (if needed)	Quantity	Description	Comments
80400

Cosyntrophin Stimulation Test

Adrenocorticol (ACTH) Stimulation Test

Cortrosyn Stimulation Test, Cortisol

4/3/2013 2:31 PM

8/20/2025 9:03 AM

updykek@mfldclin.org

23278

ACTH Stim, 30 and 60 Min Cort

ACTH Stimulation, 30 and 60 Min Cortisols

13592

Yes

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)	Lithium Heparin Green Top Tube (GTT), EDTA Lavender Top Tube (LTT), Serum Separator Tube (SST), Red Top Tube (RTT)	0.5 mL	0.4 mL	0.3 mL

GTT/RTT - physically separate plasma or serum from contact with cells as soon as possible of before transport. Separate from cells within 30 minutes to minimize uptake of corticosteroids by RBCs

CPT	Modifier (if needed)	Quantity	Description	Comments
80400			ACTH Stim Panel
82533			Cortisol, total

Cosyntrophin Stimulation Test

Adrenocorticol (ACTH) Stimulation Test

Cortrosyn Stimulation Test, Cortisol

4/3/2013 2:56 PM

2/26/2025 11:40 AM

drexlerk@mfldclin.org

26231

APCRVSO

Activated Protein C Resistance V, Plasma (APCRV)

14977

Yes

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen 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

CPT	Modifier (if needed)	Quantity	Description	Comments
85307		1

Activated Protein CV deficient

APCRV (Activated Protein C Resistance V)

6/18/2020 2:51 PM

6/22/2022 1:29 PM

pionkowd@mfldclin.org

Collection Instructions:

1. Centrifuge, transfer all plasma into a vial, and centrifuge plasma again.

2. Aliquot plasma into a vial leaving 0.25 mL in the bottom of centrifuged vial.

3. Freeze plasma immediately (no longer than 4 hours after collection) at -20 degrees C, or, ideally < or =-40 degrees C

Additional Information:

1. Double-centrifuged specimen is critical for accurate results as platelet contamination may cause spurious results.

2. If priority specimen, mark request form, give reason, and request a call-back.

3. Each coagulation assay requested should have its own vial.

22166

ACRNSO

Acylcarnitines, Quantitative (ACRN)

11818

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82017

2-Methylbutyryl-CoA Dehydrogenase Deficiency
3-Methylcrotonyl Carboxylase Deficiency
Biotinidase (Multiple Carboxylase) Deficiency
CPT-II (Carnitine Palmitoyl Transferase Deficiency Type II)
Electron-Transfer Flavoprotein (ETF) Deficiency
Glutaric Acidemia (GA)
Glutaric Acidemia Type I (GA I)
Glutaric Acidemia Type II (GA II)
Glutaryl-CoA Dehydrogenase (GCDH) Deficiency
Isobutyryl-CoA Dehdrogenase (IBDH) Deficiency
Isovaleric Acidemia (IVA)
Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase (LCHAD) Deficiency
MADD (Multiple Acyl-CoA Dehydrogenase Deficiency)
Malonic aciduria
Medium-Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency
Methylmalonic Acidemia
Methylmalonic Aciduria (MMA)
Multiple Acyl-CoA Dehydrogenase Deficiency (MADD)
S/MCHAD (Short/Medium-Chain 3-Hydroxyacyl-CoA Dehydrogenase) Deficiency
SCAD (Short-Chain Acyl-CoA Dehydrogenase) Deficiency
Short/Medium-Chain 3-Hydroxyacyl-CoA Dehydrogenase (S/MCHAD) Deficiency
Trifunctional Protein (TFP) Deficiency
Very Long-Chain Acyl-CoA Dehydrogenase (VLCAD) Deficiency
2-Methyl-3-hydroxybutyryl CoA Dehydrogenase Deficiency
3-Hydroxy-3-Methylglutaryl-CoA (HMG-CoA) Lyase Deficiency
3-Methylglutaconyl-CoA Hydratase Deficiency
Beta-ketothiolase Deficiency
Carnitine-acylcarnitine Translocase (CACT) Deficiency
Formiminoglutamic Aciduria (FIGLU)
Formiminotransferase (FIGLU) Deficiency
Holocarboxylase Synthetase Deficiency
Succinyl-CoA Ligase (SUCLA2) Deficiency
SUCLA2 (Succinyl-CoA Ligase) Deficiency
3-Methylglutaconic Aciduria Type I
3-Methylglutaconic Aciduria Type 1
Propionic Acidemia (PA)

4/3/2013 2:31 PM

6/23/2022 2:49 PM

pionkowd@mfldclin.org

Submit sample in a plastic vial.

Draw specimen just prior to a scheduled meal or feeding.

Additional Information:

1. Patient's age is required.

2. Include family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.

26299

AGU20SO

Acylglycines, Quantitative, Random, Urine (AGU20)

15046

Yes

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	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.

CPT	Modifier (if needed)	Quantity	Description	Comments
82542		1

2-Methylbutyryl Glycinuria
2-Methylbutyryl-CoA Dehydrogenase Deficiency
EE (Ethylmalonic Encephalopathy)
Ethylmalonic Encephalopathy (EE)
GA 1 (Glutaric Acidemia Type 1)
GA 2 (Glutaric Acidemia Type 2)
GA II (Glutaric Acidemia Type II)
GAII (Glutaric Acidemia Type 2)
GCDH (Glutaryl-CoA Dehydrogenase) Deficiency
Glutaric Acidemia (GA)
Glutaric Acidemia Type 2
Glutaric Acidemia Type I (GA I)
Glutaric Acidemia Type II (GA II)
Glutaryl-CoA Dehydrogenase (GCDH) Deficiency
Isovaleric Acidemia (IVA)
Isovaleryl-CoA Dehydrogenase (IVD)
IVA (Isovaleric Acidemia)
MADD
MCAD (Medium-Chain Acyl-CoA Dehydrogenase) Deficiency
MCKAT (Medium-Chain 3-Ketoacyl-CoA Thiolase) Deficiency
Medium-Chain 3-Ketoacyl-CoA Thiolase (MCKAT) Deficiency
Medium-Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency
SBCAD (Short/Branched-Chain Acyl-CoA Dehydrogenase) Deficiency
SCAD (Short-Chain Acyl-CoA Dehydrogenase) Deficiency
Short-Chain Acyl-CoA Dehydrogenase (SCAD) Deficiency
Short/Branched-Chain Acyl-CoA Dehydrogenase (SBCAD) Deficiency
n-Acetylglycine
n-Propionylglycine
Isobutyrylglycine
Ethylmalonic acid
n-Butyrylglycine
2-Methylsuccinic acid
2-Methylbutyrylglycine
Isovalerylglycine
Glutaric acid
3-Methylcrotonylglycine
n-Tiglylglycine
3-Methylglutaconic acid
n-Hexanoylglycine
n-Octanoylglycine
3-Phenylpropionylglycine
trans-Cinnamoylglycine
Suberylglycine
Dodecanedioic acid
Tetradecanedioic acid
Hexadecanedioic acid

Acylglycines, Qnt, Ur (AGU20)

2/11/2021 12:01 PM

5/16/2024 8:22 AM

chadwica@mfldclin.org

1. Collect a random urine specimen.

2. No preservative.

NECESSARY INFORMATION

1. Patient's age and sex are required.

2. Include family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.

26217

ADALXSO

Adalimumab Quantitative with Reflex to Antibody, Serum (ADALX)

14963

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.35 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
80145		1
83520		1		if needed

Humira

6/10/2020 11:39 AM

6/23/2022 3:08 PM

pionkowd@mfldclin.org

Patient Preparation: For 12 hours before specimen collection, it is recommended that the patient not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.

24877

ADAMTSO

ADAMTS13 Evaluation (1295)

14455

Yes

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 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

CPT	Quantity	Description
85397	1	ADAMTS13 Activity
85335	1	ADAMTS13 Inhibitor (if performed)
83520	1	ADAMTS13 Antibody (if performed)

ADAMTS13 Activity, ADAMTS13, ADAMTS13 Inhibitor, VWF Cleaving Protease

5/10/2013 9:25 AM

4/22/2021 1:29 PM

drexlerk@mfldclin.org

Ship sample frozen.

25008

ADAMT13

ADAMTS13 Evaluation, Rapid

14096

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

CPT	Modifier (if needed)	Quantity	Description	Comments
85397

ADAMTS Activity

4/3/2013 3:02 PM

3/21/2016 4:37 PM

busedj@mfldclin.org

This test should be regarded as 'Research Use Only'. The performance characteristics were determined by Marshfield Labs in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration. It may not be covered by insurance and providers need to inform all patients of this prior to ordering.

For Medicare patients, an Advanced Beneficiary notice (ABN) is required; for Medicaid patients, a Noncovered Services Waiver is required, and for commercial payers, prior authorization should be obtained.

One 0.75 mL citrated Blue Top Tube (BTT) plasma aliquot.
If more than one coagulation test is ordered, a separate aliquot is needed for each test.
-Collect in Citrated Blue Top Tube (BTT)
-Citrate anticoagulant must be adjusted for HCT >55%
-Tube must be at least 90% full
-Invert completely 3-4 times (without shaking) to mix
-See (Preparation of Platelet Poor Plasma)

Plasma must be removed from cells and frozen within 2 hours.

26283

FADPFSO

Adenosine Deaminase, Pleural Fluid (FADPF)

15030

Yes

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
Pleural Fluid	Leak Proof Container		0.5 mL	0.2 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
84311		1

ADA Pleural

11/16/2020 3:27 PM

6/24/2022 9:57 AM

pionkowd@mfldclin.org

Collect Pleural fluid in a leak proof container; centrifuge specimen at room temperature, transfer 0.5 mL to standard tube and freeze. Ship frozen.

Note: Specimen must remain frozen until received at performing lab.

26533

LADVSO

Adenovirus, Molecular Detection, PCR, Varies (LADV)

15282

Yes

Specimen Type	Preferred Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)
Body Fluid (Pleural, peritoneal, ascites, pericardial, or amniotic)	Sterile Container	0.5 mL	0.5 mL
Respiratory (Bronchial washing, bronchoalveolar lavage, nasopharyngeal aspirate or washing, sputum, or tracheal aspirate)	Sterile Container	1 mL	0.5 mL
Cerebrospinal Fluid	Sterile Vial	0.5 mL	0.3 mL
Stool	Stool Collection kit	1 g	0.5 g
Nasal	Swab placed in multimicrobe medium (M4-RT, M4, or M5) or Eswab
Throat	Swab placed in multimicrobe medium (M4-RT, M4, or M5) or Eswab
Genital	Swab placed in multimicrobe medium (M4-RT, M4, or M5 or Eswab
Ocular	Swab placed in multimicrobe medium (M4-RT, M4, or M5) or Eswab
Tissue	Sterile container containing 1 mL to 2 mL of sterile saline or multimicrobe medium (M4-RT, M4, or M5)	Entire Collection
Urine (Random)	Sterile Container	1 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
87798

ADV (Adenovirus)

4/6/2023 11:37 AM

11/16/2023 10:59 AM

chadwica@mfldclin.org

Specimen source is required. Submit only 1 of the above specimens

Do not centrifuge body fluids or cerebrospinal fluid

Place Swab in a multimicrobe medium (M4-RT, M4, or M5)

Collect fresh tissue specimens

22168

ACTH-P

Adrenocorticotropic Hormone (ACTH)

11822

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82024

ACTH, Corticotropin

4/3/2013 2:31 PM

10/25/2024 1:48 PM

drexlerk@mfldclin.org

1. Morning (6 a.m.-10:30 a.m.) specimen is desirable.
2. Collect with a pre-chilled pink or lavender top (EDTA) tube and transport to the laboratory on ice.
3. Centrifuge at refrigerated temperature within 2 hours and immediately separate plasma from cells.
4. If sample is received on “off-hours", immediately freeze plasma. If during normal business hours (M-F, 8am – 3pm), deliver to department on wet ice.

For outreach clients without a refrigerated centrifuge: Please deliver to Marshfield Labs within 2 hours of collection in a chilled tube, transported on ice. Or schedule the patient to be drawn at a location with a refrigerated centrifuge.

22169

ALT

Alanine Amino Transferase

11824

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
84460

SGPT, Alanine Amino Transaminase

4/3/2013 2:31 PM

8/21/2025 11:21 AM

mcdonad@mfldclin.org

Samples collected in a RTT or GTT must be removed from the clot within one hour for storage or transport. Samples collected in gel barrier tubes must be removed from the primary tube prior to transporting to Marshfield. Do not send the primary collection tube.

22171

ALB

Albumin

11828

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82040

4/3/2013 2:31 PM

8/21/2025 11:24 AM

mcdonad@mfldclin.org

Separate plasma or serum from the blood within 60 minutes of venipuncture.

Venostasis should be avoided when collecting samples since hemoconcentration increases the apparent concentrations of albumin and other plasma proteins.

Samples collected in gel barrier tubes must be removed from primary tubes prior to transporting to Marshfield.

22170

ALB-O

Albumin, Body Fluid

11826

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82042

Body Fluid Albumin, ALB-O

4/3/2013 2:31 PM

8/21/2025 11:23 AM

mcdonad@mfldclin.org

Specify source.

If bacterial contamination is suspected, freeze specimen at -20°C.

Remove needle before transporting to laboratory.

22173

ALC

Alcohol, Blood

11832

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82077		1

Ethanol, Ethyl Alcohol, ETOH

4/3/2013 2:31 PM

8/21/2025 11:26 AM

mcdonad@mfldclin.org

DO NOT use alcohol or other volatile disinfectants while collecting the specimen.

Body fluids with serum-like matrices may also be analyzed, but have no pre-defined reference ranges.

26548

ALSSO

Aldolase, Serum (ALS)

15297

Yes

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)
Serum	Red Top Tube (RTT)		1 mL	0.5 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
82085		1

Aldolase, S; Fructose-Biphosphate Aldolase

5/24/2023 9:04 AM

5/24/2023 9:38 AM

chadwica@mfldclin.org

Centrifuge within 1 hour of collection and aliquot serum into plastic vial.

Send refrigerated.

22178

ALDOSO

Aldosterone, 24 Hour, Urine (ALDU)

11840

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82088

Aldosterone w/Sodium, U
Aldosterone with Sodium, Urine
Aldosterone 24 Hour Urine (ALDU)
24 ALDOSO

4/3/2013 2:31 PM

11/12/2024 3:10 PM

drexlerk@mfldclin.org

Patient Prepartion: Spironolactone (Aldactone) should be discontinued for 4 to 6 weeks before testing.

1. Collect urine for 24 hours.

2. 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. This preservative is intended to achieve a pH of between approximately 2 and 4.

Indicate total 24 hour urine volume on request form. The total volume collected must be measured, recorded, and included with the test request

Additional Information:

1. 24-Hour volume is required.

2. See Urine Preservatives for multiple collections and Renin-Aldosterone Studies for more detailed instructions in Special Instructions (see Mayo website).

22177

ALDSSO

Aldosterone, Serum (ALDS)

11838

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82088

4/3/2013 2:31 PM

6/30/2022 10:38 AM

pionkowd@mfldclin.org

8 a.m. draw time (after the patient is active for 2 hours) is recommended; preferably no later than 10 a.m.

26152

ALDSSOTEST

Aldosterone, Serum (ALDS) Test

14874

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

CPT	Modifier (if needed)	Quantity	Description	Comments
82088

6/13/2019 1:34 PM

1/20/2021 9:50 AM

drexlerk@mfldclin.org

This test should be regarded as 'Research Use Only'. This test has not been cleared or approved by the U.S. Food and Drug Administration. It may not be covered by insurance and providers need to inform all patients of this prior to ordering.

8 a.m. draw time (after the patient is active for 2 hours) is recommended; preferably no later than 10 a.m.

24914

ALKRESO

ALK (2p23) Rearrangement, FISH, Tissue (LCAF)

14413

Yes

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

CPT	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

Lung carcinoma, Non-small cell lung cancer (NSCLC)

4/11/2013 9:58 AM

6/22/2022 1:50 PM

pionkowd@mfldclin.org

1. A pathology report is required in order for testing to be performed. Acceptable pathology reports include working drafts, preliminary pathology or surgical pathology reports.

2. A reason for testing must be provided. If this information is not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.

Tissue Block Collection Instructions: Submit a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block. Blocks prepared with alternative fixation methods may be acceptable; provide fixation method used.

Submit tissue block or slides.

For blocks residing at a Non-Clinic location, please complete the Surgical Pathology Specimen Request form found in FORMS PRINTER or found here:

Surgical Pathology Specimen Request

22183

ALKP

Alkaline Phosphatase, Total

11848

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
84075

Alk P'tase, Phosphatase, Alkaline, ALKP

4/3/2013 2:31 PM

8/21/2025 11:27 AM

mcdonad@mfldclin.org

26646

ALKPSO

Alkaline Phosphatase, Total and Isoenzymes, Serum (ALKP)

15396

Yes

Fasting Required	Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
8 hours	Serum	Serum Separator Tube (SST)	Red Top Tube (RTT)	1 mL	1 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
84075		1
84080		1

Alkaline Phosphatase, Tot and Iso,S

1/30/2025 11:44 AM

2/3/2025 8:04 AM

chadwica@mfldclin.org

Patient's age and sex are required.

Within 2 hours of collection, centrifuge the specimen.

For red top tubes, immediately aliquot into a plastic vial.

For serum gel tubes, serum may sit on gel refrigerated but must be aliquoted within 7 days.

26090

ALANSSO

Allergen IgE, Anise (ANSE)

14804

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Aniseed, Pimpinella anisum, Sweet Alice, Sweet Cumin

4/24/2018 7:47 AM

7/11/2022 3:11 PM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space.

26070

ALASCSO

Allergen IgE, Ascaris (ASCRI)

14789

Yes

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)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Ascaris lumbricoides, Common Roundworm

3/21/2018 11:45 AM

5/8/2023 3:16 PM

chadwica@mfldclin.org

26092

ALBROSO

Allergen IgE, Broccoli (BROC)

14806

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Brassica oleracea var. italica
Calabrese
Purple Cauliflower
Romanesco
Spear Cauliflower
Winter Cauliflower

4/24/2018 8:03 AM

7/11/2022 3:29 PM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space

26071

ALBFTSO

Allergen IgE, Budgerigar Feathers (BFTH)

14790

Yes

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)	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Budgeri Feathers
Budgie feathers
Parakeet Feathers

3/21/2018 11:52 AM

5/3/2023 2:15 PM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

0.5 mL for every 5 allergens requested

26093

ALFEESO

Allergen IgE, Ferret Epithelium (FEEP)

14807

Yes

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)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Epithelium, ferret
Mustela putorius
Polecat

4/24/2018 8:09 AM

5/9/2023 9:12 AM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space

26377

FDP1SO

Allergen IgE, Food Panel #2, Serum (FDP1)

15126

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Cabbage, Paprika, Spinach, Tomato

2/2/2022 1:39 PM

2/2/2022 1:50 PM

pionkowd@mfldclin.org

26074

ALGSTSO

Allergen IgE, Green String Bean (GSTB)

14793

Yes

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)	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Bean
Common Bean
French Bean
Green Bean
Haricot Bean
Phaseolus vulgaris
Snap Bean
Wax Bean

3/21/2018 12:14 PM

5/4/2023 2:23 PM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

0.5 mL for every 5 allergens requested

26075

ALGUISO

Allergen IgE, Guinea Pig Epithelium (GUIN)

14794

Yes

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)	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Cavin porcellus
Cavy

3/21/2018 12:20 PM

5/4/2023 2:27 PM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

26409

SQUASO

Allergen IgE, Squash, Serum (SQUA)

15158

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Cheese Pumpkin, Cucumis pepo, Cucurbita maxima, Cucurbita pepo, Curcurbita mixta, Field Pumpkin, Naked-Seeded Pumpkin, Pimpkin, Pumpkin

2/9/2022 11:27 AM

2/9/2022 11:41 AM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL

For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

26373

WHEYSO

Allergen IgE, Whey, Serum (WHEY)

15122

Yes

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 for every 5 allergens requested	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Cow's Whey

2/2/2022 12:55 PM

2/2/2022 1:06 PM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL

For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

26091

ALBENSO

Allergen IgE, White Bean (BENW)

14805

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Bean
Cannellini Bean
Great Northern Bean
Haricot Bean
Marrow Bean
Phaseolus vulgaris
Pinto Bean
White Kidney Bean

4/24/2018 7:55 AM

7/13/2022 11:41 AM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space

23300

ALFODSO

Allergen Panel, Food (FOOD6)

13626

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Codfish, Cow, Egg White, IgE-Antibodies Multi-Allergen, Milk, Peanut, Soybean, Wheat

4/3/2013 2:56 PM

5/8/2023 12:44 PM

chadwica@mfldclin.org

26287

APGALSO

Allergen Panel, Galactose-Alpha-1, 3-Galactose (Alpha-Gal) Mammalian Meat Allergy Profile, Serum (APGAL)

15034

Yes

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)	Red Top Tube (RTT)	1.5 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		4
86008		1

Galactose IgE
Galactose-alpha-1,3
Alpha-Gal

12/3/2020 11:55 AM

10/31/2023 11:52 AM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

24930

ALMOLD

Allergen Panel, Mold (MOLD1)

13984

Yes

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)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

IgE Antibodies, Multi-Allergen

Includes: Alternaria tenuis, Aspergillus fumingatus, Candida albicans, Cladosporium herbarum, Helminthosporium halodes, Penicillium notatum

4/3/2013 3:00 PM

5/4/2023 3:17 PM

chadwica@mfldclin.org

24981

ALNT1SO

Allergen Panel, Nut #1 (FOOD8)

14060

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Almond, Brazilnut, Coconut, Hazelnut, IgE Antibodies, Multi-Allergen, Peanut

4/3/2013 3:01 PM

5/4/2023 11:40 AM

chadwica@mfldclin.org

24797

ALPED1

Allergen Panel, Ped <3 Years (PAS3)

13818

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		5	Allergen specific IgE

Allergen-Multiple, Allergen-Specific IgE (Immunoglobulin E) Antibody Screen
Includes: Egg White, Milk, Wheat, Soybean, House Dust Mites/D.F

4/3/2013 2:58 PM

5/8/2023 3:00 PM

chadwica@mfldclin.org

24799

ALPED3

Allergen Panel, Ped >8 Years (PAS8)

13822

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		5	Allergen specific IgE

Allergen-Multiple, Allergen-Specific IgE (Immunoglobulin E) Antibody Screen
Includes: House Dust Mites/D.F., Short Ragweed, Timothy Grass, Cat Epithelium, Alternaria Tenuis

4/3/2013 2:58 PM

5/8/2023 3:06 PM

chadwica@mfldclin.org

24798

ALPED2

Allergen Panel, Ped 3-8 Years (PAS38)

13820

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		6	Allergen specific IgE

Allergen-Multiple, Allergen-Specific IgE (Immunoglobulin E) Antibody Screen
Includes: Egg White, House Dust Mites/D.F., Timothy Grass, Short Ragweed, Cat Epithelium, Alternaria Tenuis

4/3/2013 2:58 PM

5/8/2023 3:04 PM

chadwica@mfldclin.org

https://testreference.marshfieldlabs.org/sites/ltrm/Human/Search/SitePages/results.aspx?k=PrimarySendoutID:354&s=Human

23246

MRAST

Allergen Panel, Stinging Insects-5 Allergens (INSEC)

13532

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		5

Honeybee Venom, Wasp Venom, White Faced Hornet Venom, Yellow Faced Hornet Venom, Yellow Jacket Venom

4/3/2013 2:55 PM

7/19/2022 11:44 AM

pionkowd@mfldclin.org

23254

ALTRESO

Allergen Panel, Tree #1 (TREE1)

13546

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

IgE Antibodies, Multi-Allergen
Includes: Birch, Box Elder/Maple, Elm, Oak, Walnut

4/3/2013 2:55 PM

5/8/2023 10:57 AM

chadwica@mfldclin.org

26251

ALALFSO

Allergen, Alfalfa (Medicago sativa) IgE (FALPE)

14997

Yes

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	0.5 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Medicago sativa grass FORWARD

7/1/2020 4:38 PM

7/19/2022 1:09 PM

pionkowd@mfldclin.org

Draw blood in a plain red-top tube(s), serum gel tube(s) is acceptable. Spin down and send 0.5 mL of serum refrigerated in a plastic vial.

26178

ALAMYSO

Allergen, Alpha-Amylase, IgE (AAMY)

14923

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86008		1

Aspergillus oryzae; Occupational, Alpha-amylase

1/9/2020 3:08 PM

7/19/2022 1:22 PM

pionkowd@mfldclin.org

25678

ALANCSO

Allergen, Anchovy, IgE (ANCH)

14721

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1	Anchovy, IgE

Anchovis, Ansiovis, Engraulis encrasicolus, Fish, anchovy

7/7/2017 3:38 PM

5/8/2023 3:09 PM

chadwica@mfldclin.org

25674

ALAVOSO

Allergen, Avocado, IgE (AVOC)

14717

Yes

Fasting Required

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)

Red Top Tube (RTT)

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.

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Persea americana

Varieties: Guatemalan: Persea nubigena var guatamalensis L.Wms Mexican: P. Americana var. drymifolia Blake West Indian: P. Americana Mill var. Americana(P. gratissima Gaertn)

7/7/2017 1:57 PM

5/8/2023 3:19 PM

chadwica@mfldclin.org

24826

ALBAKSO

Allergen, Bakers Yeast, IgE (BYST)

13864

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Saccharomyces cerevisiae, Yeast, Baker's, Yeast, Brewers

4/3/2013 2:59 PM

7/21/2022 11:20 AM

pionkowd@mfldclin.org

26227

ALBMBSO

Allergen, Bamboo Shoot, IgE, Serum (BAMB)

14973

Yes

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	0.5 mL for every 5 allergens requested	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Hachiku
Madaka
Moso
Phyllostachys pubescens
Pubescent Bamboo

6/10/2020 3:00 PM

7/21/2022 11:27 AM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

23379

ALBASSO

Allergen, Bass, Black, IgE (43310S)

13662

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Sea Bass, Centropristis striata

4/3/2013 2:56 PM

5/10/2024 2:37 PM

chadwica@mfldclin.org

Ship at ambient or frozen temperature Monday through Friday.

23401

ALBBSO

Allergen, Black Bean, IgE (34410E)

13684

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Phaseolus spp

4/3/2013 2:57 PM

5/10/2024 2:28 PM

chadwica@mfldclin.org

Ship at ambient or frozen temperature Monday through Friday.

26220

ALBLPSO

Allergen, Black/White Pepper, IgE, Serum (BLPEP)

14966

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Black Pepper

Pepper

Piper nigrum

White Pepper

6/10/2020 12:40 PM

8/16/2022 10:41 AM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

26233

ALMSSSO

Allergen, Blue Mussel, IgE (MUSS)

14979

Yes

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 (STT)	0.5 mL for every 5 allergens requesed	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Mytilus edulis

6/18/2020 3:15 PM

8/16/2022 11:07 AM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

24935

ALBLUSO

Allergen, Blueberry, IgE (BLUE)

13992

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Blueberry fruit, Fruit blueberry, Highbush Blueberry, Lowbush Blueberry, Vaccinium myrtillis

4/3/2013 3:00 PM

5/3/2023 1:47 PM

chadwica@mfldclin.org

26249

ALBUCSO

Allergen, Buckwheat, IgE (BUCW)

14995

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Beech Wheat
Canadian Buckwheat
Fagopyrum
Fagopyrum esculentum
French Wheat

7/1/2020 4:18 PM

8/16/2022 1:25 PM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

26230

ALBDRSO

Allergen, Budgerigar Droppings, IgE, Serum (BDRP)

14976

Yes

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)	Red Top Tube (RTT)	0.5 mL for every 5 allergens requested	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Budgie Droppings
Melopsittacus undulatus droppings
Parakeet droppings

6/17/2020 10:00 AM

5/3/2023 1:53 PM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

26248

ALCFTSO

Allergen, Canary Feathers, IgE, Serum (CFTH)

14994

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Serinus canarius

7/1/2020 4:06 PM

9/1/2022 2:54 PM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

23377

ALCTFSO

Allergen, Catfish, IgE (43210S)

13658

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Siluriformes spp

4/3/2013 2:56 PM

5/10/2024 1:25 PM

chadwica@mfldclin.org

Ship at ambient or frozen temperature Monday through Friday.

25236

ALCFLSO

Allergen, Cauliflower (CALFL)

14467

Yes

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)	Red Top Tube (RTT)	0.5 mL for every 5 allergens requested	For 1 allergen: 0.3 mL More than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Brassica oleracea var. botrytis
Broccoflower
Calabrese
Romanesco

5/20/2013 8:29 AM

5/3/2023 2:30 PM

chadwica@mfldclin.org

25105

ALMCHSO

Allergen, Cheese Mold, IgE (MCHZ)

14252

Yes

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)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Brie, Camembert, Cheese Mold Serum, Gorgonzola, Mold, Cheese, Roquefort

4/3/2013 3:03 PM

5/3/2023 2:34 PM

chadwica@mfldclin.org

25011

ALCHESO

Allergen, Cheese, Cheddar, IgE (CCHZ)

14102

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Cheese, Cheddar

4/3/2013 3:02 PM

5/3/2023 2:32 PM

chadwica@mfldclin.org

25668

ALCHRSO

Allergen, Cherry, IgE (CHER)

14714

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Prunus Avium

7/7/2017 1:13 PM

5/8/2023 3:25 PM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

26244

ALCTRSO

Allergen, Chestnut Tree, IgE, Serum (CTRE)

14990

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Castanea sativa
Chestnut
European Chestnut
Sweet Chestnut

7/1/2020 3:34 PM

9/1/2022 4:26 PM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space

25194

ALCNTSO

Allergen, Chestnut, Sweet (CNUT)

14338

Yes

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)	Red Top Tube (RTT)	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 deadspace

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Chestnut sweet, nut
Chestnut, sweet, Nuts
European Chestnut
Nuts, Chestnut, sweet
Spanish Chestnut

4/3/2013 3:05 PM

5/3/2023 3:02 PM

chadwica@mfldclin.org

25670

ALCHXSO

Allergen, Chick Pea, IgE (CHXP)

14713

Yes

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)	Red Top Tube (RTT)	0.5 mL for every 5 allergens requested	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Bengal gram, Cicer arietinus, Garbanzo Beans

7/7/2017 1:04 PM

5/8/2023 3:27 PM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

25237

ALCINSO

Allergen, Cinnamon (CINN)

14468

Yes

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)	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 deadspace

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Ceylon cinnamon
Cinnamomum spp.
True cinnamon

5/20/2013 8:34 AM

5/3/2023 3:07 PM

chadwica@mfldclin.org

25664

ALCLVSO

Allergen, Clove, IgE (CLOV)

14709

Yes

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)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Caryophyllus aromaticus, Eugenia caryophyllata, Syzygium aromaticum

7/7/2017 10:06 AM

5/8/2023 3:32 PM

chadwica@mfldclin.org

26246

ALCRISO

Allergen, Coriander, IgE, Serum (CORI)

14992

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Cilantro
Coriander, herb
Coriandrum sativum
Herb, Coriander

7/1/2020 3:58 PM

9/7/2022 3:10 PM

pionkowd@mfldclin.org

For 1 allergen: 0.3 mL; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space

24743

ALCRNSO

Allergen, Cranberry, IgE (CRANB)

13772

Yes

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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

O. intermedius, O. oxycoccus, O. quadripetalus, Oxycoccus palustris, V. hagerupii, Vaccinium oxycoccus

4/3/2013 2:58 PM

9/7/2022 3:40 PM

pionkowd@mfldclin.org

25669

ALCRYSO

Allergen, Crayfish, IgE (CRAY)

14715

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Astacus astacus, Crawfish, Fish, crayfish

7/7/2017 1:22 PM

5/8/2023 3:38 PM

chadwica@mfldclin.org

25671

ALCUCSO

Allergen, Cucumber, IgE (CUKE)

14712

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Cowcumber. Cucumber, vegetable, Cucumis sativus, Cuke, Gherkin

7/7/2017 12:56 PM

5/8/2023 3:42 PM

chadwica@mfldclin.org

26242

ALFNHSO

Allergen, Finch Feathers, IgE, Serum (FINCH)

14988

Yes

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)	Red Top Tube (RTT)	0.5 mL for every 5 allergens requested	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Brambling Feathers
Bunting Feathers
Cardinal Feathers
Crossbill Feathers
Feathers, finch
Goldfinch Feathers
Grosbeak Feathers
Junco Feathers
Linnet Feathers
Lonchura domestrica
Siskin Feathers
Sparrow Feathers
Towhee Feathers

7/1/2020 3:13 PM

5/9/2023 9:14 AM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL; For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL dead space

26243

ALFANSO

Allergen, Fire Ant, IgE, Serum (FANT)

14989

Yes

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)	Red Top Tube (RTT)	0.5 mL for every 5 allergens requested	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Solenopsis invicta

7/1/2020 3:23 PM

5/9/2023 9:19 AM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

25035

ALFRBSO

Allergen, Firebush, IgE (FBSH)

14142

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Bassia scoparia, Chenopodium scoparia, Common kochia, Kochia (Firebush), Kochia scoparia

4/3/2013 3:02 PM

5/4/2023 11:25 AM

chadwica@mfldclin.org

26224

ALFOOD2

Allergen, Food-Fruit Panel, Serum (FOOD2)

14970

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Apple
Banana
IgE Antibodies, Multi-Allergen
Peach
Pear

6/10/2020 2:17 PM

5/9/2023 9:16 AM

chadwica@mfldclin.org

26226

ALFOOD4

Allergen, Food-Grain Panel (FOOD4)

14972

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Barley
IgE Antibodies, Multi-Allergen
Rice
Rye
Wheat

6/10/2020 2:47 PM

5/9/2023 9:21 AM

chadwica@mfldclin.org

23395

ALGELSO

Allergen, Gelatin, IgE (GELA)

13676

Yes

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)	Red Top Tube (RTT)	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

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Bovine gelatin

4/3/2013 2:56 PM

5/4/2023 11:49 AM

chadwica@mfldclin.org

26234

ALGINSO

Allergen, Ginger, IgE (GING)

14980

Yes

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)	Red Top Tube (RTT)	0.5 mL for every 5 allergens requested	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003		1

Ginger Root
Green (Fresh) Ginger
Zingiber officinale

6/18/2020 3:29 PM

5/9/2023 9:36 AM

chadwica@mfldclin.org

For 1 allergen: 0.3 mL
For more than 1 allergen: (0.05 mL x number of allergens) + 0.25 mL deadspace

23240

ALGRASO

Allergen, Grass Panel 1 (GRAS1)

13522

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

IgE Antibodies, Multi-Allergen, Includes: June/Kentucky Blue, Meadow Fescue, Orchard, Rye, Timothy

4/3/2013 2:55 PM

5/4/2023 11:57 AM

chadwica@mfldclin.org

25048

ALGR2SO

Allergen, Grass Panel 2 (GRAS2)

14164

Yes

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)	Red Top Tube (RTT)	0.5 mL	0.3 mL

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

IgE Antibodies Multi-Allergen
Includes: Bermuda, Bahia, Johnson, June/Kentucky Blue, Rye, Timothy

4/3/2013 3:02 PM

5/4/2023 2:17 PM

chadwica@mfldclin.org

25199

ALGPESO

Allergen, Green Pea, IgE (GPEA)

14348

Yes

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)	Red Top Tube (RTT)	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 deadspace

CPT	Modifier (if needed)	Quantity	Description	Comments
86003

Common Pea, Dry Pea, Garden Pea, Snow Pea, Sugar Snap Pea, Pisum humile, Pisum sativum

4/3/2013 3:05 PM

5/4/2023 2:25 PM

chadwica@mfldclin.org

1 - 100

View in Web Browser

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0x0

0x1

FileType

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255

View in Web Browser

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0x0

0x1

FileType

vsdx

255

View in Web Browser

/sites/ltrm/Human/_layouts/15/VisioWebAccess/VisioWebAccess.aspx?listguid={ListId}&itemid={ItemId}&DefaultItemOpen=1

0x0

0x1

FileType

vsdm

255

Compliance Details

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0x0

0x1

ContentType

0x01

898

Edit in Browser

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/sites/ltrm/Human/_layouts/15/formserver.aspx?XsnLocation={ItemUrl}&OpenIn=Browser&Source={Source}

0x0

0x1

FileType

xsn

255

Edit in Browser

/_layouts/15/images/icxddoc.gif?rev=40

/sites/ltrm/Human/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}

0x0

0x1

ProgId

InfoPath.Document

255

Edit in Browser

/_layouts/15/images/icxddoc.gif?rev=40

/sites/ltrm/Human/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}

0x0

0x1

ProgId

InfoPath.Document.2

255

Edit in Browser

/_layouts/15/images/icxddoc.gif?rev=40

/sites/ltrm/Human/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}

0x0

0x1

ProgId

InfoPath.Document.3

255

Edit in Browser

/_layouts/15/images/icxddoc.gif?rev=40

/sites/ltrm/Human/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}

0x0

0x1

ProgId

InfoPath.Document.4

255

View in Browser

javascript:(function(){var a=document.createElement('a');a.href=SPClientTemplates.Utility.ReplaceUrlTokens('~site/_layouts/15/xlviewer.aspx?id={ItemUrl}&DefaultItemOpen=1');GoToLinkOrDialogNewWindow(a)})()

0x0

0x1

FileType

xlsx

255

View in Browser

0x0

0x1

FileType

xlsm

255

View in Browser

0x0

0x1

FileType

xlsb

255

View in Browser

0x0

0x1

FileType

ods

255

Document Set Version History

/_layouts/15/images/versions.gif?rev=40

javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+ '/_layouts/15/DocSetVersions.aspx' + '?List={ListId}&ID={ItemId}')

0x0

ContentType

0x0120D520

330

Send To other location

/_layouts/15/images/sendOtherLoc.gif?rev=40

javascript:GoToPage('{SiteUrl}' + '/_layouts/15/docsetsend.aspx' + '?List={ListId}&ID={ItemId}')

0x0

ContentType

0x0120D520

350

Pages This system library was created by the Publishing feature to store pages that are created in this site. // <![CDATA[ _spBodyOnLoadFunctionNames.push("setupPageDescriptionCallout"); // ]]>

Pages

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