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Test ID: ADHP
Familial Hypercholesterolemia/Autosomal Dominant Hypercholesterolemia Genetic Testing Reflex Panel

List Fee Provides the Mayo Medical Laboratories list fee for performing the test

$305.00

The following test(s) will be added at an additional charge: 

$165.50 for #26968 DNA Extraction, AutoPure 

 

$470.50 = Total List Fee 

 

 

The following test(s) may be added per the testing algorithm: 

$891.10 for #29284 Familial Hypercholesterolemia, LDLR Full Gene Sequencing 

$455.70 for #29285 Familial Hypercholesterolemia, LDLR Large Deletion/Duplication, Molecular Analysis 

$602.80 for #29286 LDLR Gene Sequencing

NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.

Conditional

CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

Familial Hypercholesterolemia/Autosomal Dominant Hypercholesterolemia Genetic Interpretation

83912

 

Apolipoprotein B-100 Molecular Analysis, R3500Q and R3500W

83892-Enzymatic digestion

83898-Amplification, target, each nucleic acid sequence

83914-Mutation identification by enzymatic ligation or primer extension, single segment, each segment

 

DNA Extraction, AutoPure

83891

 

Familial Hypercholesterolemia, LDLR Full Gene Sequencing

83892 x 8-Enzymatic digestion (if appropriate)

83894 x 8-Separation by gel electrophoresis (if appropriate)

83898 x 3-Amplification, target, each nucleic acid sequence (if appropriate)

83900-Amplification, target, multiplex, first 2 nucleic acid sequences (if appropriate)

83901 x 6-Amplification, target, multiplex, each additional nucleic acid sequence beyond 2 (if appropriate)

 

Familial Hypercholesterolemia, LDLR Large Deletion/Duplication, Molecular Analysis

83896 x 19-Nucleic acid probe, each (if appropriate)

83900-Amplification, target, multiplex, first 2 nucleic acid sequences (if appropriate)

83901 x 17-Amplification, target, multiplex, each additional nucleic sequence beyond 2 (if appropriate)

83909-Separation and identification by high-resolution technique (if appropriate)

 

LDLR Gene Sequencing

83909 x 32 (if appropriate)