Chromosomal microarray analysis (CMA) - Blood

Alphabetical Test listing

Chromosomal microarray analysis (CMA) - Blood-4280F

Test name:

Test number:

4280F

Excellian order number:

LAB4280F

Alternate names:

CMA
CGH
aCGH
Array CGH
CYG
Microarray
Comparative genomic hybridization
Cytogenomic array
Congenital

Specimen type:

Sodium heparin (Na hep) whole blood and EDTA whole blood

Collection container:

Dk green Sodium heparin (Na hep), no gel

and

Lavender (EDTA), 4mL

Both tubes (Dk green and lavender) are required for testing

Volume:

5.0 mL

Minimum volume:

2.0 mL

Collection instructions:

Immediately following collection, mix sample thoroughly by gently inverting 8 - 10, times to prevent clotting

Processing instructions:

Send whole blood specimens in original tubes. Do not aliquot.

Transport container:

Dk green Sodium heparin (Na hep), no gel

and

Lavender (EDTA), 4mL

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 (strict)

Refrigerated - NO

Frozen - NO

Reason for rejection:

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

Performing lab:

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

Days set up:

Mo - Fr

TAT:

8 - 21 days
TAT may be extended if additional confirmatory studies are needed

Method:

Microarray

Reference ranges:

An interpretive report will be provided

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
88230 - culture

Confirmation/Visualization Studies:
Reflex (if appropriate):
88261 - Limited chromosome study
88271 x 2 - FISH probes
88273 - metaphase FISH analysis
88271 - interphase FISH analysis

Subject to medical necessity (Y/N):

Yes

Other billing information:

Medical necessity

Molecular Medicare billing request

Date created:

07/03/2012

Revised date:

05/15/2024

Review date:

01/10/2024