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Alpha-globin gene analysis-12674

Test info

Test name:

Alpha-globin gene analysis

Test number:

12674

Excellian order number:

LAB12674

Abbreviation:

ALPHA-GLOBUL

Alternate names:

AGPB
Alpha globin
Alpha thalassemia
Alpha-thalassemia
Constant Spring
HBA1
HBA2
Hemoglobin Bart
Hemoglobin-H disease
Hydrops fetalis
Saudi

Useful for:

Diagnosis of alpha-thalassemia
Prenatal diagnosis of deletional alpha-thalassemia
Carrier screening for individuals from high-risk populations for alpha-thalassemia

Specimen

Specimen type:

EDTA whole blood

Collection container:

Lavender (EDTA), 4mL

Volume:

3.0 mL

Minimum volume:

1.0 mL

Collection instructions:

Immediatley following collection, mix sample by inverting 8 - 10 times to prevent clotting

Transport container:

Lavender (EDTA), 4mL

Alternate specimen type:

ACD whole blood

Alternate collection container:

Yellow ACD (A or B)

Alternate transport container:

Yellow ACD (A or B)

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 Medical billing request form along with the sample.

Complete and submit the form to notify us of the need for Allina Health Laboratory to bill insurance for Molecular testing performed
All information requested is required in order for your request to be completed

Transport and stability:

Ambient (preferred) - 96 hours

Refrigerated - 96 hours

Prenatal specimens can be sent Mo - Th and must be received by 5 p.m. CST on Friday in order to be processed appropriately.

Performance

Performing lab:

Mayo Clinic Laboratories (ATHAL): R-MM

Days set up:

2x/week

TAT:

12 - 14 days

Method:

Dosage Analysis by Polymerase Chain Reaction (PCR)/Multiplex Ligation-Dependent Probe Amplification (MLPA)/Luminex Technology

Clinical and Interpretive info

Reference ranges:

An interpretive report will be provided

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:

81269

Subject to medical necessity (Y/N):

Yes

LCD/NCD:

Medical necessity

Molecular Medicare Billing Request

Tracking

Date created:

01/26/2017

Revised date:

01/02/2024

Review date:

01/02/2024