Fragile X syndrome, PCR with reflex to Southern Blot

Alphabetical Test listing

Fragile X syndrome, PCR with reflex to Southern Blot-13567

1/15/2024: This test has been discontinued. To order a referred alternate, place an MSO order for LabCorp 481684 Fragile X Syndrome, Carrier

Test name:

Fragile X syndrome, PCR with reflex to Southern Blot

Test number:

13567

Excellian order number:

LAB13567

Abbreviation:

FRAXA

Useful for:

Carrier screening for individuals who are pregnant or considering pregnancy and who have no family or personal history of fragile X syndrome, fragile X-related disorders (primary ovarian insufficiency, or late-onset ataxia) or unexplained intellectual disabilities, developmental delay, or autism.

Specimen type:

EDTA whole blood

Collection container:

Lavender (EDTA), 4mL x 3

Volume:

10 mL

Collection instructions:

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

Transport container:

Lavender (EDTA), 4mL x 3

Alternate specimen type:

ACD whole blood

Alternate collection container:

Lavender (EDTA), 10mL

Yellow ACD (A or B)

Alternate transport container:

Lavender (EDTA), 10mL

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

Reason for rejection:

Frozen specimen
Hemolysis
Quantity not sufficient for analysis (QNS)
Improper container
Unlabeled or mislabeled specimen
PCR testing cannot be added on to a sample that has been opened and/or used for other testing. If the sample has already been used for testing, a new specimen will need to be collected.

Performing lab:

LabCorp RTP (511919): R-LC

Days set up:

PCR - Daily
Southern blot - 1x per week

TAT:

6 - 14 days

Method:

Polymerase chain reaction (PCR) followed by capillary electrophoresis with reflex to Southern blot (SB) analysis for all positive samples.

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:

81243

Subject to medical necessity (Y/N):

Yes

LOINC code:

Result 77202-0

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:

03/29/2019

Revised date:

01/23/2024

Review date:

01/02/2024