| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, Serum
Message***Test not built in Epic. Charges start at $4,000. Test has several reflex testing that can add over $2,000 in additional testing.***
Test Code
94955
CPT Codes
86255 (x19), 86052, 86341, 83519 (x2), 86596 (x2)
Includes
Initial panel consits of: Encephalitis Ab Screen Tissue IFA, AMPAR1, AMPAR2, Aquaporin 4, DPPX, GABAbR, NMDAR1, CASPAR2, LGI1, Ganglionic AChR, VGCC N-Type, VGCC P/Q-Type, and VGKC.
1) A line blot consisting of 10 analytes will be performed at an additional charge (CPT codes(s): 84182 x9, 86341) as a reflex for tissue mosaic IFA suggesting one or more of the analytes on the line blot: ANNA1 (Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CV2 (CRMP5), Amphiphysin, AGNA1 (SOX1), GAD65, DNER, and Zic4. If the tissue mosaic pattern suggests ANNA3, then titer will be performed at an additional charge (CPT code(s): 86256).
2) If the tissue mosaic pattern suggests PCA-2, then titer will be performed at an additional charge (CPT code(s): 86256).
3) If the tissue mosaic IFA suggests PCA-Tr (DNER) and Western Blot shows DNER negative and Yo negative, then cell based assay IFA for DNER will be performed at an additional charge (CPT codes(s): 86255)
a. If DNER CBA is positive, then titer will be performed at an additional charge (CPT code(s): 86256).
4) If the tissue mosaic IFA suggests myelin antibody, then
a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256).
b. Myelin Associated Glycoprotein (MAG) Antibody, in turn reflexing to MAG-SGPG and MAG ELISA for quantitation, will be performed at an additional charge (CPT code(s): 83520 x2).
5) If the Mosaic CBA is positive for any given analyte (NMDAR1, AMPAR1, AMPAR2, GABA-B Receptor, LGI-1, CASPR2), and the individual CBAs DPPX and Aquaporin 4 antibody, then that analyte will be titered at an additional charge (CPT code(s): 86256 per titer, 86052 for AQP4 Titer).
6) If DPPX is positive, then titer will be performed at an additional charge (CPT code(s): 86256).
7) If the Aquaporin 4 (NMO, neuromyelitis optica) CBA is positive, then Aquaporin 4 CBA titer will be performed at an additional charge (CPT code(s): 86052).
1) A line blot consisting of 10 analytes will be performed at an additional charge (CPT codes(s): 84182 x9, 86341) as a reflex for tissue mosaic IFA suggesting one or more of the analytes on the line blot: ANNA1 (Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CV2 (CRMP5), Amphiphysin, AGNA1 (SOX1), GAD65, DNER, and Zic4. If the tissue mosaic pattern suggests ANNA3, then titer will be performed at an additional charge (CPT code(s): 86256).
2) If the tissue mosaic pattern suggests PCA-2, then titer will be performed at an additional charge (CPT code(s): 86256).
3) If the tissue mosaic IFA suggests PCA-Tr (DNER) and Western Blot shows DNER negative and Yo negative, then cell based assay IFA for DNER will be performed at an additional charge (CPT codes(s): 86255)
a. If DNER CBA is positive, then titer will be performed at an additional charge (CPT code(s): 86256).
4) If the tissue mosaic IFA suggests myelin antibody, then
a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256).
b. Myelin Associated Glycoprotein (MAG) Antibody, in turn reflexing to MAG-SGPG and MAG ELISA for quantitation, will be performed at an additional charge (CPT code(s): 83520 x2).
5) If the Mosaic CBA is positive for any given analyte (NMDAR1, AMPAR1, AMPAR2, GABA-B Receptor, LGI-1, CASPR2), and the individual CBAs DPPX and Aquaporin 4 antibody, then that analyte will be titered at an additional charge (CPT code(s): 86256 per titer, 86052 for AQP4 Titer).
6) If DPPX is positive, then titer will be performed at an additional charge (CPT code(s): 86256).
7) If the Aquaporin 4 (NMO, neuromyelitis optica) CBA is positive, then Aquaporin 4 CBA titer will be performed at an additional charge (CPT code(s): 86052).
Preferred Specimen
8 mL frozen serum
Minimum Volume
4 mL
Transport Container
Transport tube
Transport Temperature
Frozen
Specimen Stability
Room temperature: 24 hours
Refrigerated: 48 hours
Frozen: 21 days
Refrigerated: 48 hours
Frozen: 21 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis •Lipemia • Received room temperature • Received refrigerated • Freeze/thaw greater than 3 cycles
Reference Range
See Laboratory Report
Clinical Significance
The Encephalitis Antibody Panel provides an evaluation of possible autoantibodies in patients with suspected autoimmune encephalitis, and optimizes the likelihood of detecting neuronal specific autoantibodies, whether present singly or occurring as multiple autoantibodies.
Performing Laboratory
| Quest Diagnostics Nichols Institute-San Juan Capistrano, CA |
| 33608 Ortega Highway |
| San Juan Capistrano, CA 92675-2042 |