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Test ID LBOR0148 SLCO1B1 Genotyping

Important Note

This test is rarely covered by insurance.  A Patient Acknowledgement Form for Pharmacogenomics Services is required to accompany the specimen for all Medicare and non-Medicare patients.  In addition, for Medicare patients, and ABN Form should also be submitted.  In the absence of the appropriate signed form(s), 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

CPT

81328

Instructions

This testing requires that a Patient Acknowledgment Form for Pharmacogenomics Services must be filled out for all Medicare and non-Medicare patients and submitted with the sample for testing to be performed. In addition, Medicare patients require an ABN Form to also be submitted with the specimen.

 

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

Additional Information

Uses for this test:

 

  • Estimate genetic risk of statin-related muscle toxicity.
  • This test is recommended for patients treated with simvastatin at a dose equal to or greater than 40 mg per day and for individuals with a personal or family history of adverse effects to medications that are substrates of SLCO1B1.

The test includes the identification of the following variant alleles:

SLCO1B1*17, *5, *1B.

 

See Solute Carrier Organic Anion Transporter Family, Member 1B1 (SLCO1B1) Genotyping Medical Providers form for additional information.

See Solute Carrier Organic Anion Transporter Family, Member 1B1 (SLCO1B1) Genotyping Technical Specifications for additional information.

AKA

Statins

Interfering Substances

Hemolysis - NA

Lipemia - NA