Hepatitis C virus (HCV) FibroSure

Alphabetical Test listing

Hepatitis C virus (HCV) FibroSure-13569

Test name:

Test number:

13569

Excellian order number:

LAB13569

Abbreviation:

FIBRO

Alternate names:

ActiTest
HCV
HCV Fibrosure
FibroSure
FibroTest

Useful for:

Assessment of liver status following a diagnosis of HCV
Baseline determination of liver status before initiating HCV therapy
Posttreatment assessment of liver status six months after completion of therapy
Noninvasive assessment of liver status in patients who are at increased risk of complications from a liver biopsy

Patient preparation information:

Patient should be fasting for at least eight hours prior to sample collection

Fasting for a blood test

Specimen type:

Serum

Collection container:

Gold serum separator (SST) tube

Volume:

3.5 mL

Minimum volume:

2.0 mL

Collection instructions:

Immediately following collection, thoroughly mix sample by gently inverting 5 times

Processing instructions:

Allow sample to clot for a minimum of 30 minutes
Spin within two (2) hours of specimen collection
Transfer serum to a Screw-cap polypropylene frozen transport vial/tube - 4mL (LabCorp), labelled as serum
Freeze

Transport container:

Screw-cap polypropylene frozen transport vial/tube - 4mL (LabCorp)

Alternate collection container:

Red serum vial/tube, 10 mL

Alternate processing instructions:

Allow sample to clot
Spin within two (2) hours of specimen collection
Transfer serum to a Screw-cap polypropylene frozen transport vial/tube - 4mL (LabCorp), labelled as serum
Freeze

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:

Frozen (preferred) - 7 days

Frozen samples are stable for one freeze/thaw cycle.

Refrigerated - 72 hours

Ambient - 72 hours

Reason for rejection:

Gross hemolysis
Gross lipemia
Improper labeling
Non-fasting specimen
Patient younger than 14 years of age

Performing lab:

LabCorp Burlington (550123): R-LC

Days set up:

Mo - Fr

TAT:

3 - 5 days

Reference ranges:

Fibrosis Stage (FibroTest)	Range
F0−No fibrosis	0.00−0.21
F0−F1	>0.21−0.27
F1−Portal fibrosis	>0.27−0.31
F1−F2	>0.31−0.48
F2−Bridging fibrosis with few septa	>0.48−0.58
F3−Bridging fibrosis with many septa	>0.58−0.72
F3−F4	>0.72−0.74
F4−Cirrhosis	>0.74−1.00

Activity Stage (ActiTest)	Range
A0−No activity	0.00−0.17
A0−A1	>0.17−0.29
A1−Minimal activity	>0.29−0.36
A1−A2	>0.36−0.52
A2−Moderate activity	>0.52−0.60
A2−A3	>0.60−0.63
A3−Severe activity	>0.63−1.00

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:

81596

Subject to medical necessity (Y/N):

Yes

LOINC code:

Result 1975-2

Other billing information:

Medical necessity

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

Molecular Medicare billing request

Date created:

04/05/2019

Revised date:

02/11/2022

Review date:

03/01/2022