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Unit Code 83631:
Connective Tissue Diseases Cascade, Serum

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

$162.40

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

$92.60 for #8178 "DNA Double-Stranded (ds-DNA) Antibodies, IgG, Serum"

$163.80 for #89035 "Antibody to Extractable Nuclear Antigen Evaluation, Serum"

$118.60 for #87837 "Ribosome P Antibodies, IgG, Serum"

$97.70 for #9278 "Centromere Antibodies, IgG, Serum"

Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.

This test has been cleared or approved by the U.S. Food and

Drug Administration and is used per manufacturer's instructions.

CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each unit code 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.

86038/ANA

86200/Cyclic citrullinated  antibodies, IgG

83520/x2 Centromere and ribosome P (if appropriate)

86225/ds-DNA (if appropriate)

86235/x6 RNP, Sm, SS-B, SS-A, Jo 1, and Scl 70 (if appropriate)