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Chromosomal Microarray Analysis (CMA) - Products of Conception-4280C

Test info

Test name:

Chromosomal Microarray Analysis (CMA) - Products of Conception

Test number:

4280C

Excellian order number:

LAB4280C

Alternate names:

CMA
CGH
aCGH
array CGH
Microarray
Comparative genomic hybridization
Cytogenomic array

Specimen

Specimen type:

Placental tissue: Chorionic villi (preferred) or placenta (acceptable)

Collection container:

Sterile culture medium, sterile Hanks Balance Salt Solution (HBSS) or sterile saline

Volume:

Chorionic villi: 30mg
Placenta: 50 mg

Collection instructions:

Place specimen in sterile culture media, sterile Hanks Balanced Salt Solution (HBSS) or sterile saline
Do not send the entire placenta

Transport container:

Sterile culture medium, sterile Hanks Balance Salt Solution (HBSS) or sterile saline

Alternate specimen type:

Fetal tissue (secondary tissue)

Alternate collection instructions:

Collect a 1 cm³ internal tissue or 3 mm³ skin biopsy from a central location such as buttock or upper thigh
Do not submit the entire fetus

Required forms/information:

Molecular Medicare billing request

Hospital clients submitting a request for this assay on an outpatient with Medicare should complete and submit a Molecular Medicare billing request form to notify us of the need for Allina Health Laboratory to bill insurance.

Transport and stability:

Ambient - 48 hours

Refrigerate if not transporting the same day

Frozen - NO

Reason for rejection:

Specimens submitted in formalin
Improper label (unlabeled or mislabeled)
Wrong container (solution)
Improper blood/anticoagulant ratio
Delay in transport
Improper storage
Leaking container

Performance

Performing lab:

Mayo Clinic Laboratories (Technical only)
AHL - Cytogenetics: X (Interpretation)

Days set up:

Mo - Fr

TAT:

21 - 30 days
TAT may be extended if additional confirmation studies are needed or if cultured cells are needed for CMA.

Method:

Microarray

Clinical and Interpretive info

Reference ranges:

Interpretive report

Billing

Preauthorization:

This test may require preauthorization from the insurance provider. Check the payer guidelines and, if needed, obtain the pre-authorization prior to sample collection.

CPT codes:

81229 (copy number + SNP) or 81228 (copy number only)
88233 (culture)

Subject to medical necessity (Y/N):

Yes

Other billing information:

Medical necessity

Molecular Medicare billing request

Tracking

Date created:

05/26/2015

Revised date:

05/15/2024

Review date:

01/10/2024