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Test ID LBOR0142 Basic PharmGX Panel

Important Note

This test is rarely covered by insurance.  A Patient Agreement for Self-Pay Pharmacogenomic Services form is required to accompany the specimen for all Medicare and non-Medicare patients.  In the absence of the appropriate signed form, the ordering provider/facility will be billed. 

For patients with Blue Cross Blue Shield of North Dakota coverage, a separate completed and signed Advance Member Notice is required to accompany the specimen.

Container Type

EDTA

Sterile Container

Specimen Type/Requirements

EDTA Whole Blood

Extracted DNA

Specimen Volume

2.0 - 4.0 mL

Stability

Room Temperature - 72 hours

Refrigerated - 28 days

Frozen - 28 days

Transport Temperature

Refrigerated

Performed Test Frequency

Monday through Friday

Methodology

Allele-specific PCR

Performing Lab

Sanford Molecular

Analytical Time

10 - 14 days

Minimum Volume

1.0 mL

Instructions

This testing requires that a Patient Agreement for Self-Pay Pharmacogenomic Services form must be filled out for all Medicare and non-Medicare patients and submitted with the sample for testing to be performed.

 

For patients with Blue Cross Blue Shield of North Dakota coverage, a separate completed and signed Advance Member Notice is required to be sent with the specimen.

 

All specimens should be sent in the original container and should not be aliquoted to another tube. In addition, the specimen submitted should ONLY be used for this testing and should not be shared with any other testing that would also utilize this specimen type.

AKA

Warfarin

Plavix

Codeine

Clopidogrel

Statins

CYP2C9

CYP2C19

CYP2D6

Additional Information

The following 8 genes are included in this panel:

 

  • CYP2C9
  • VKORC1
  • SLCO1B1
  • TPMT
  • DPYD
  • CY2C19
  • CYP3A5
  • CYP2D6

Uses for Test:

  • To estimate genetic risk of abnormal drug metabolism due to specific gene variants involving multiple drug classes including but not limited to categories such as statins, specific psychologic and pain medications and anti-coagulants.
  • To identify genotypes indicative or a personal or family history of an adverse drug reaction or therapeutic failure for a large group of drugs and thereby guide drug and dose selection.

See Basic Pharmacogenetic Panel Testing for Medical Providers for additional information.

See Basic Pharmacogenetic Panel Testing Technical Specifications for additional information.

CPT

81479

Interfering Substances

Hemolysis: NA

Lipemia: NA