Myelin Protein Zero (MPZ) DNA Sequencing Test

Test Code
120811

CPT Codes
81405

Physician Attestation of Informed Consent
This germline genetic test requires physician attestation that patient consent has been received if ordering medical facility is located in AK, DE, FL, GA, IA, MA, MN, NV, NJ, NY, OR, SD or VT or test is performed in MA.

Preferred Specimen
8 mL whole blood collected in an EDTA (lavender-top) tube, or
Pediatric volume: 2 mL

Minimum Volume
6 mL
Pediatric: 1 mL

Instructions
Informed consent required.

Please label each specimen tube with two forms of patient identification. These forms of identification must also appear on the requisition form.

Shipping conditions: Avoid freezing. Must arrive Monday through Friday.

Please note: Higher blood volumes ensure adequate DNA quantity, which varies with WBC, specimen condition, and need for confirmatory testing. Patients, 0-3 years have higher WBC, yielding more DNA per mL of blood.

Transport Temperature
Room temperature

Specimen Stability
Room temperature: 10 days
Refrigerated: 10 days
Frozen: Unacceptable

Methodology
Next Generation Sequencing

Setup Schedule
Set up: Varies; Report available: 21-28 days

Reference Range
No sequence variation detected

Clinical Significance
Test detects sequence variations in the Myelin Protein Zero gene.

Performing Laboratory
Athena Diagnostics, Inc.
200 Forest Street, 2nd Floor
Marlborough, MA 01752



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.