Alpha-globin gene analysis

Alphabetical Test listing

Alpha-globin gene analysis-12674

Test name:

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 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 Medicare billing request form to notify us of the need for Allina Health Laboratory to bill insurance.

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.

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

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:

81269

Subject to medical necessity (Y/N):

Yes

Other billing information:

Medical necessity

Molecular Medicare Billing Request

Date created:

01/26/2017

Revised date:

05/15/2024

Review date:

01/02/2024