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Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Serum

Message
This test is designed for patients age 18 and older. If your patient is under age 18, and you suspect an autoimmune neurological disorder, we recommend PCDES (Pediatric Autoimmune Encephalopathy/CNS Disorder Evaluation, Serum). Please consult our Neurology specialty website for more information.


Test Code
ENS2


Alias/See Also
Epic: LAB16852
Mayo: ENS2


CPT Codes
86255 x 21 86341 x 1 84182-AGNBS (if appropriate) 86256 AGNTS (if appropriate) 86255-AINCS (if appropriate) 86256-AMPIS (if appropriate) 86256 APHTS (if appropriate) 84182-AMIBS (if appropriate) 84182-AN1BS (if appropriate) 86256 AN1TS (if appropriate) 84182-AN2BS (if appropriate) 86256 AN2TS (if appropriate) 86256 AN3TS (if appropriate) 86256 CRMTS (if appropriate) 84182-CRMWS (if appropriate) 86255-DPPCS (if appropriate) 86256-DPPTS (if appropriate) 86256-GABIS (if appropriate) 86255-GFACS (if appropriate) 86256-GFATS (if appropriate) 86255-IG5CS (if appropriate) 86256-IG5TS (if appropriate) 86255-GL1CS (if appropriate) 86256-GL1TS (if appropriate) 86255 NCDCS (if appropriate) 86256 NCDTS (if appropriate) 86255-NFHCS (if appropriate) 86256-NIFTS (if appropriate) 86255-NFLCS (if appropriate) 86256-NMDIS (if appropriate) 84182-PC1BS (if appropriate) 86256 PC1TS (if appropriate) 86256 PC2TS (if appropriate) 84182-PCTBS (if appropriate) 86256 PCTTS (if appropriate) 86255 SP7CS (if appropriate) 86256 SP7TS (if appropriate)

Includes

PROFILE INFORMATION 

Test Id Reporting Name Available Separately Always Performed
AEESI Encephalopathy, Interpretation, S No Yes
AMPCS AMPA-R Ab CBA, S No Yes
AMPHS Amphiphysin Ab, S No Yes
AGN1S Anti-Glial Nuclear Ab, Type 1 No Yes
ANN1S Anti-Neuronal Nuclear Ab, Type 1 No Yes
ANN2S Anti-Neuronal Nuclear Ab, Type 2 No Yes
ANN3S Anti-Neuronal Nuclear Ab, Type 3 No Yes
CS2CS CASPR2-IgG CBA, S No Yes
CRMS CRMP-5-IgG, S No Yes
DPPIS DPPX Ab IFA, S No Yes
GABCS GABA-B-R Ab CBA, S No Yes
GD65S GAD65 Ab Assay, S Yes Yes
GFAIS GFAP IFA, S No Yes
IG5IS IgLON5 IFA, S No Yes
LG1CS LGI1-IgG CBA, S No Yes
GL1IS mGluR1 Ab IFA, S No Yes
NCDIS Neurochondrin IFA, S No Yes
NIFIS NIF IFA, S No Yes
NMDCS NMDA-R Ab CBA, S No Yes
PCABP Purkinje Cell Cytoplasmic Ab Type 1 No Yes
PCAB2 Purkinje Cell Cytoplasmic Ab Type 2 No Yes
PCATR Purkinje Cell Cytoplasmic Ab Type Tr No Yes
SP7IS Septin-7 IFA, S No Yes

REFLEX TESTS 

Test Id Reporting Name Available Separately Always Performed
AGNBS AGNA-1 Immunoblot, S No No
AINCS Alpha Internexin CBA, S No No
AMPIS AMPA-R Ab IF Titer Assay, S No No
AMIBS Amphiphysin Immunoblot, S No No
AN1BS ANNA-1 Immunoblot, S No No
AN2BS ANNA-2 Immunoblot, S No No
CRMWS CRMP-5-IgG Western Blot, S Yes No
DPPCS DPPX Ab CBA, S No No
DPPTS DPPX Ab IFA Titer, S No No
GABIS GABA-B-R Ab IF Titer Assay, S No No
GFACS GFAP CBA, S No No
GFATS GFAP IFA Titer, S No No
IG5CS IgLON5 CBA, S No No
IG5TS IgLON5 IFA Titer, S No No
GL1CS mGluR1 Ab CBA, S No No
GL1TS mGluR1 Ab IFA Titer, S No No
NFHCS NIF Heavy Chain CBA, S No No
NIFTS NIF IFA Titer, S No No
NFLCS NIF Light Chain CBA, S No No
NMDIS NMDA-R Ab IF Titer Assay, S No No
PC1BS PCA-1 Immunoblot, S No No
PCTBS PCA-Tr Immunoblot, S No No
AGNTS AGNA-1 Titer, S No No
APHTS Amphiphysin Ab Titer, S No No
AN1TS ANNA-1 Titer, S No No
AN2TS ANNA-2 Titer, S No No
AN3TS ANNA-3 Titer, S No No
CRMTS CRMP-5-IgG Titer, S No No
NCDCS Neurochondrin CBA, S No No
NCDTS Neurochondrin IFA Titer, S No No
PC1TS PCA-1 Titer, S No No
PC2TS PCA-2 Titer, S No No
PCTTS PCA-Tr Titer, S No No
SP7CS Septin-7 CBA, S No No
SP7TS Septin-7 IFA Titer, S No No

TESTING ALGORITHM 

 
If client requests or if the immunofluorescence (IFA) patterns suggest collapsin response-mediator protein-5-IgG (CRMP-5-IgG), then CRMP-5-IgG IFA titer and CRMP-5-IgG Western blot will be performed at an additional charge.
 
If the IFA patterns suggest amphiphysin antibody, then amphiphysin IFA titer and amphiphysin immunoblot will be performed at an additional charge.
 
If the IFA pattern suggests antiglial nuclear antibody (AGNA)-1, then AGNA-1 IFA titer and AGNA-1 immunoblot will be performed at an additional charge.
 
If the IFA pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then ANNA-1 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed at an additional charge.
 
If the IFA pattern suggests ANNA-2 antibody, then ANNA-2 IFA titer, ANNA-2 immunoblot, and ANNA-1 immunoblot will be performed at an additional charge.
 
If the IFA pattern suggests Purkinje cytoplasmic antibody type 1 (PCA-1), then PCA-1 IFA titer and PCA-1 immunoblot will be performed at an additional charge.
 
If IFA pattern suggests PCA-Tr antibody, then PCA-Tr IFA titer and PCA-Tr immunoblot will be performed at an additional charge.
 
If the IFA pattern suggests IgLON5 antibody, then IgLON5 IFA titer and IgLON5 cell-binding assay (CBA) will be performed at an additional charge.
 
If AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptor antibody CBA is positive, then AMPA-receptor antibody IFA titer assay will be performed at an additional charge.
 
If gamma-aminobutyric acid B (GABA-B) receptor antibody is positive, then GABA-B-receptor antibody IFA titer assay will be performed at an additional charge.
 
If the IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then GFAP IFA titer and GFAP CBA will be performed at an additional charge.
 
If N-methyl-D-aspartate (NMDA) receptor antibody CBA is positive, then NMDA-receptor antibody IFA titer assay will be performed at an additional charge.
 
If the IFA pattern suggests dipeptidyl-peptidase-like protein-6 (DPPX) antibody, then DPPX antibody CBA and DPPX IFA titer will be performed at an additional charge.
 
If the IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then mGluR1 antibody CBA and mGluR1 IFA titer will be performed at an additional charge.
 
If the IFA pattern suggests neuronal intermediate filament (NIF) antibody, then alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF IFA titer will be performed at an additional charge.
 
For more information, see the following algorithms:
-Autoimmune/Paraneoplastic Encephalopathy Evaluation Algorithm-Serum
-Central Nervous System Demyelinating Disease Diagnostic Algorithm
-Meningitis/Encephalitis Panel Algorithm


Preferred Specimen

Specimen Type: Serum
Collection Container: Serum gel
Specimen Volume: 4 mL




Patient Preparation
  1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication or intravenous immunoglobulin treatment.
  2. This test should not be requested for patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed or canceled if radioactivity remains.


Minimum Volume
2.5 mL


Other Acceptable Specimens

Collection Container: Red top




Instructions
Centrifuge and aliquot serum into a plastic vial.


Transport Container
Plastic vial


Specimen Stability
Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days  
  Frozen 28 days  
  Ambient 72 hours
 


Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject


Methodology
AGN1S, AGNTS, AMPHS, APHTS, AMPIS, ANN1S, AN1TS, ANN2S, AN2TS, AN3TS, ANN3S, CRMS, CRMTS, DPPIS, DPPTS, GABIS, GFAIS, GFATS, IG5IS, IG5TS, GL1IS, GL1TS, NCDIS, NCDTS, NIFIS, NIFTS, NMDIS, PCABP, PC1TS, PCAB2, PC2TS, PCATR, PCTTS, SP7IS, SP7TS: Indirect Immunofluorescence Assay (IFA) 

AMPCS, CS2CS, DPPCS, GABCS, GFACS, IG5CS, LG1CS, GL1CS, NCDCS, AINCS, NFLCS, NFHCS, NMDCS, SP7CS: Cell Binding Assay (CBA) 

CRMWS: Western Blot (WB)

AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS: Immunoblot (IB)

GD65S: Radioimmunoassay (RIA)

Setup Schedule
Profile tests: Monday through Sunday; Reflex tests: Varies


Report Available
8 to 12 days


Limitations
CAUTIONS 
Negative results do not exclude autoimmune encephalopathy or cancer.

This test does not detect Ma1 or Ma2 antibodies (also known as MaTa), which are sometimes associated with brainstem and limbic encephalitis in the context of testicular germ cell neoplasms. Scrotal ultrasound is advised for men who present with unexplained subacute encephalitis.

Intravenous immunoglobulin (IVIg) treatment prior to the serum collection may cause a false-positive result.


Reference Range

REFERENCE VALUES 

Test ID Reporting name Methodology* Reference value
AEESI Encephalopathy, Interpretation, S Medical interpretation NA
AMPCS AMPA-R Ab CBA, S CBA Negative
AMPHS Amphiphysin Ab, S IFA Negative
AGN1S Anti-Glial Nuclear Ab, Type 1 IFA Negative
ANN1S Anti-Neuronal Nuclear Ab, Type 1 IFA Negative
ANN2S Anti-Neuronal Nuclear Ab, Type 2 IFA Negative
ANN3S Anti-Neuronal Nuclear Ab, Type 3 IFA Negative
CS2CS CASPR2-IgG CBA, S CBA Negative
CRMS CRMP-5-IgG, S IFA Negative
DPPIS DPPX Ab IFA, S IFA Negative
GABCS GABA-B-R Ab CBA, S CBA Negative
GD65S GAD65 Ab Assay, S RIA < or =0.02 nmol/L
Reference values apply to all ages.
GFAIS GFAP IFA, S IFA Negative
IG5IS IgLON5 IFA, S IFA Negative
LG1CS LGI1-IgG CBA, S CBA Negative
GL1IS mGluR1 Ab IFA, S IFA Negative
NCDIS Neurochondrin IFA, S IFA Negative
NIFIS NIF IFA, S IFA Negative
NMDCS NMDA-R Ab CBA, S CBA Negative
PCABP Purkinje Cell Cytoplasmic Ab Type 1 IFA Negative
PCAB2 Purkinje Cell Cytoplasmic Ab Type 2 IFA Negative
PCATR Purkinje Cell Cytoplasmic Ab Type Tr IFA Negative
SP7IS Septin-7 IFA, S IFA Negative

Reflex Information:
Test ID Reporting name Methodology* Reference value
AGNBS AGNA-1 Immunoblot, S IB Negative
AGNTS AGNA-1 Titer, S IFA <1:240
AINCS Alpha Internexin CBA, S CBA Negative
AMPIS AMPA-R Ab IF Titer Assay, S IFA <1:240
APHTS Amphiphysin Ab Titer, S IFA <1:240
AMIBS Amphiphysin Immunoblot, S IB Negative
AN1BS ANNA-1 Immunoblot, S IB Negative
AN1TS ANNA-1 Titer, S IFA <1:240
AN2BS ANNA-2 Immunoblot, S IB Negative
AN2TS ANNA-2 Titer, S IFA <1:240
AN3TS ANNA-3 Titer, S IFA <1:240
CRMTS CRMP-5-IgG Titer, S IFA <1:240
CRMWS CRMP-5-IgG Western Blot, S WB Negative
DPPCS DPPX Ab CBA, S CBA Negative
DPPTS DPPX Ab IFA Titer, S IFA <1:240
GABIS GABA-B-R Ab IF Titer Assay, S IFA <1:240
GFACS GFAP CBA, S CBA Negative
GFATS GFAP IFA Titer, S IFA <1:240
IG5CS IgLON5 CBA, S CBA Negative
IG5TS IgLON5 IFA Titer, S IFA <1:240
GL1CS mGluR1 Ab CBA, S CBA Negative
GL1TS mGluR1 Ab IFA Titer, S IFA <1:240
NCDCS Neurochondrin CBA, S CBA Negative
NCDTS Neurochondrin IFA Titer, S IFA <1:240
NFHCS NIF Heavy Chain CBA, S CBA Negative
NIFTS NIF IFA Titer, S IFA <1:240
NFLCS NIF Light Chain CBA, S CBA Negative
NMDIS NMDA-R Ab IF Titer Assay, S IFA <1:240
PC1BS PCA-1 Immunoblot, S IB Negative
PC1TS PCA-1 Titer, S IFA <1:240
PC2TS PCA-2 Titer, S IFA <1:240
PCTBS PCA-Tr Immunoblot, S IB Negative
PCTTS PCA-Tr Titer, S IFA <1:240
SP7CS Septin-7 CBA, S CBA Negative
SP7TS Septin-7 IFA Titer, S IFA <1:240

 *Methodology abbreviations:
Immunofluorescence assay (IFA)
Cell-binding assay (CBA)
Western blot (WB)
Radioimmunoassay (RIA)
Immunoblot (IB)
 
Neuron-restricted patterns of IgG staining that do not fulfill criteria for ANNA-1, ANNA-2, CRMP-5-IgG, PCA-1, PCA-2, or PCA-Tr may be reported as "unclassified anti-neuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable."

Note: CRMP-5 titers lower than 1:240 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy. Call the Neuroimmunology Laboratory at 800-533-1710 to request CRMP-5 Western blot.

INTERPRETATION 
Neuronal, glial, and muscle autoantibodies are valuable serological markers of autoimmune encephalopathy and of a patient's immune response to cancer. These autoantibodies are usually accompanied by subacute neurological symptoms and signs are not found in healthy subjects. It is not uncommon for more than 1 of the following autoantibody specificities to be detected in patients with an autoimmune encephalopathy:

-Plasma membrane autoantibodies: N-methyl-D-aspartate (NMDA) receptor; 2-amino-3-(5-methyl-3-oxo-1,2- oxazol-4-yl) propanoic acid (AMPA) receptor; gamma-amino butyric acid (GABA-B) receptor; neuronal ACh receptor. These are all potential effectors of neurological dysfunction.

-Neuronal nuclear autoantibodies, type 1 (ANNA-1), type 2 (ANNA-2), or type 3 (ANNA-3)

-Neuronal or muscle cytoplasmic antibodies: amphiphysin, Purkinje cell antibodies (PCA-1) and PCA-2, CRMP-5, GAD65, or striational


Clinical Significance
USEFUL FOR 
Evaluating new onset encephalopathy (noninfectious or metabolic) comprising confusional states, psychosis, delirium, memory loss, hallucinations, movement disorders, sensory or motor complaints, seizures, dyssomnias, ataxias, nausea, vomiting, inappropriate antidiuresis, coma, dysautonomias, or hypoventilation using serum specimens

The following accompaniments should increase of suspicion for autoimmune encephalopathy:
-Headache
-Autoimmune stigmata (personal or family history or signs of diabetes mellitus, thyroid disorder, vitiligo, poliosis [premature graying], myasthenia gravis, rheumatoid arthritis, systemic lupus erythematosus)
-History of cancer
-Smoking history (20 or more pack-years) or other cancer risk factors
-Inflammatory cerebral spinal fluid (or isolated protein elevation)
-Neuroimaging signs suggesting inflammation

Evaluating limbic encephalitis (noninfectious)

Directing a focused search for cancer

Investigating encephalopathy appearing during or after cancer therapy and not explainable by metastasis or drug effect

TESTING ALGORITHM 
If client requests or if the immunofluorescence (IFA) patterns suggest collapsin response-mediator protein-5-IgG (CRMP-5-IgG), then CRMP-5-IgG IFA titer and CRMP-5-IgG Western blot will be performed at an additional charge.

If the IFA patterns suggest amphiphysin antibody, then amphiphysin IFA titer and amphiphysin immunoblot will be performed at an additional charge.

If the IFA pattern suggests antiglial nuclear antibody (AGNA)-1, then AGNA-1 IFA titer and AGNA-1 immunoblot will be performed at an additional charge.

If the IFA pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then ANNA-1 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed at an additional charge.

If the IFA pattern suggests ANNA-2 antibody, then ANNA-2 IFA titer, ANNA-2 immunoblot, and ANNA-1 immunoblot will be performed at an additional charge.

If the IFA pattern suggests Purkinje cytoplasmic antibody type 1 (PCA-1), then PCA-1 IFA titer and PCA-1 immunoblot will be performed at an additional charge.

If IFA pattern suggests PCA-Tr antibody, then PCA-Tr IFA titer and PCA-Tr immunoblot will be performed at an additional charge.

If the IFA pattern suggests IgLON5 antibody, then IgLON5 IFA titer and IgLON5 cell-binding assay (CBA) will be performed at an additional charge.

If AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptor antibody CBA is positive, then AMPA-receptor antibody IFA titer assay will be performed at an additional charge.

If gamma-aminobutyric acid B (GABA-B) receptor antibody is positive, then GABA-B-receptor antibody IFA titer assay will be performed at an additional charge.

If the IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then GFAP IFA titer and GFAP CBA will be performed at an additional charge.

If N-methyl-D-aspartate (NMDA) receptor antibody CBA is positive, then NMDA-receptor antibody IFA titer assay will be performed at an additional charge.

If the IFA pattern suggests dipeptidyl-peptidase-like protein-6 (DPPX) antibody, then DPPX antibody CBA and DPPX IFA titer will be performed at an additional charge.

If the IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then mGluR1 antibody CBA and mGluR1 IFA titer will be performed at an additional charge.

If the IFA pattern suggests neuronal intermediate filament (NIF) antibody, then alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF IFA titer will be performed at an additional charge.

For more information, see the following algorithms:
-Autoimmune/Paraneoplastic Encephalopathy Evaluation Algorithm-Serum
-Central Nervous System Demyelinating Disease Diagnostic Algorithm
-Meningitis/Encephalitis Panel Algorithm

CLINICAL INFORMATION 
Autoimmune encephalopathies extend beyond the classically recognized clinical and radiological spectrum of "limbic encephalitis." They encompass a diversity of neurological presentations with subacute or insidious onset, including confusional states, psychosis, delirium, memory loss, hallucinations, movement disorders, sensory or motor complaints, seizures, dyssomnias, ataxias, eye movement problems, nausea, vomiting, inappropriate antidiuresis, coma, dysautonomias, or hypoventilation. A diagnosis of autoimmune encephalopathy should be suspected based on the clinical course, coexisting autoimmune disorder (eg, thyroiditis, diabetes), serological evidence of autoimmunity, spinal fluid evidence of intrathecal inflammation, neuroimaging or electroencephalographic abnormalities, and favorable response to trial of immunotherapy. 

Detection of one or more neural autoantibodies aids the diagnosis of autoimmune encephalopathy and may guide a search for cancer. Pertinent autoantibody specificities include:

-Neurotransmitter receptors and ion channels such as neuronal voltage-gated potassium channels (and interacting synaptic and axonal proteins, leucine-rich glioma inactivated 1 [LGI1] protein and contactin associated protein 2 [CASPR2]), ionotropic glutamate receptors (N-methyl-D-aspartate receptor [NMDA] and 2-amino-3-[5-methyl-3-oxo-1,2- oxazol-4-yl] propanoic acid [AMPA]), metabotropic gamma-aminobutyric acid (GABA)-B receptors

-Enzymes, signaling molecules, and RNA-regulatory proteins in the cytoplasm and nucleus of neurons (glutamic acid decarboxylase 65 [GAD65], collapsin response-mediator protein-5 neuronal [CRMP-5], antineuronal nuclear antibody-type 1 [ANNA-1], and ANNA-2) 

Importantly, autoimmune encephalopathies are reversible. Misdiagnosis as a progressive (currently irreversible) neurodegenerative condition is not uncommon and has devastating consequences for the patient. Clinicians must consider the possibility of an autoimmune etiology in the differential diagnoses of encephalopathy. For example, a potentially reversible disorder justifies a trial of immunotherapy for the detection of neural autoantibodies in patients presenting with symptoms of personality change, executive dysfunction, and psychiatric manifestations. 

A triad of clues helps to identify patients with an autoimmune encephalopathy:

1) Clinical presentation (subacute symptoms, onset rapidly progressive course, and fluctuating symptoms) and radiological findings consistent with inflammation
2) Detection of neural autoantibodies in serum or cerebrospinal fluid (CSF)
3) Favorable response to a trial of immunotherapy

Detection of neural autoantibodies in serum or CSF informs the physician of a likely autoimmune etiology, may heighten suspicion for a paraneoplastic basis, and guide the search for cancer. Neurological accompaniments of neural autoantibodies are generally not syndromic but diverse and multifocal. For example, LGI1 antibody was initially considered to be specific for autoimmune limbic encephalitis, but, over time, other presentations have been reported, including rapidly progressive course of cognitive decline mimicking neurodegenerative dementia. Comprehensive antibody testing is more informative than selective testing for 1 or 2 neural antibodies. Some antibodies strongly predict an underlying cancer. For example, small-cell lung carcinoma (ANNA-1, CRMP-5-IgG), ovarian teratoma (NMDA-R), and thymoma (CRMP-5 IgG). 

An individual patient's profile autoantibody may be informative for a specific cancer type. For example, in a patient presenting with encephalitis who has CRMP 5 IgG, and subsequent testing reveals muscle acetylcholine receptor (AChR) binding antibody, the findings should raise a high suspicion for thymoma. Testing of CSF for autoantibodies is particularly helpful when serum testing is negative, though in some circumstances testing both serum and CSF simultaneously is pertinent. Testing of CSF is recommended for some antibodies in particular (such as NMDA-R antibody and glial fibrillary acidic protein [GFAP]-IgG) because CSF testing is both more sensitive and specific. In contrast, serum testing for LGI1 antibody is more sensitive than CSF testing.


Performing Laboratory
Mayo Clinic Laboratories - Rochester
3050 Superior Drive NW
Rochester, MN 55901

Additional Information
Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Serum

Last Updated: August 17, 2023
Last Review: N. Wolford, August 17, 2023


The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.