HCV with Reflex to HIV, HBV Core, HBV Surface, HBV Surface Qualitative

Test Code

901965

CPT Codes
87522<br>Restricted Client Code

Includes

For test code 901965:
If test code 35645 Hepatitis C Viral RNA, Quantitative Real-Time PCR viral load is positive, a non-orderable code 902053 HIV 1/2 Ag/Ab, HBcAb, HBsAg, HBsAb will be added at an additional charge (CPT codes: 87389, 86704, 87340, 86706).

For non-orderable test code 902053:
If HIV Ag, Ab, 4th Generation Screen is Repeatedly Reactive, then nonorderable test code 901698, HIV-1/2 Antibody Differentiation will be performed at an additional charge (CPT codes: 86701, 86702).

If HIV-1/2 Antibody Differentiation is Indeterminate or Negative, then, HIV-1 RNA, Qualitative Real-Time PCR will be performed at an additional charge (CPT code: 87535).

Preferred Specimen

2 mL plasma collected in an EDTA (lavender-top) tube and 4 mL serum (x2) - See Instructions

Minimum Volume

1 mL plasma
2 mL serum (x2)

Instructions

Reflexes:
Tube #1 for Test Code 91431:
4 mL (2 mL minimum) serum collected in serum separator tube (SST) or red-top tube (no gel)

Serum: Collect in a serum separator tube (SST) or red-top tube (no gel). The tube should be centrifuged after clotting.

Spun SSTs may be submitted at Room Temperature or Refrigerated unopened without transfer to a plastic screw-cap vial.

Red-top tube (no gel) serum should be transferred to a plastic screw-cap vial and submitted for testing.

Plasma: Collect in EDTA (lavender top) tube and centrifuge tube within 24 hours of collection. Transfer plasma to a plastic screw-cap vial, label as plasma, and submit for testing.

Submitted tubes must be labeled with patient identifier and submitted only for HIV testing.

--AND--
Tube #2 for test code(s): 501, 498, and 499:
4 mL (2 mL minimum) serum in serum separator tube (SST) or red-top tube (no gel)
--AND--
Tube #3 for Screening Test Code 35645 - 2 mL (1 mL minimum) Plasma collected in EDTA (lavender-top)

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Room temperature: 72 hours
Refrigerated: 5 days
Frozen: 5 days

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

Gross hemolysis • Frozen SST

Methodology
Real-Time Polymerase Chain Reaction (PCR)

Setup Schedule

Set up: Daily; Report available: 2 days

Reference Range

HCV RNA, QN, Real-Time PCR	<1.70 Log IU/mL
HCV RNA, QN, Real-Time PCR	<50 IU/mL

Clinical Significance

Useful in monitoring therapy and disease progression. Reportable range is 43-69, 000, 000 IU/mL.

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.