Medical Genetics Test Details

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The American Medical Association (AMA) Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes listed, are provided for informational purposes only. The codes reflect our interpretation of CPT/HCPCS coding requirements based upon AMA guidelines published annually. CPT/HCPCS codes are provided only as guidance to assist clients with billing. Baylor Genetics strongly recommends that clients confirm CPT/HCPCS codes with their Medicare Administrative Contractor (MAC) or other payer being billed, as requirements may differ. CPT coding is the sole responsibility of the billing party. Baylor Genetics assumes no responsibility for billing errors due to reliance on the CPT codes listed. Please direct any questions regarding CPT coding to the payer being billed.

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Mitochondrial Respiratory Chain Complex I-V Nuclear Gene Deficiency Panel by Massively Parallel Sequencing (BCM-MitomeNGS^SM)
Test Information:	Mitochondrial respiratory chain contains 5 complexes, e.g. complex I, II, III, IV and V, which plays a critical role for generating ATP. Dysfunction of mitochondrial respiratory chain may cause a group of heterogeneous disorders with a variety of clinical presentations. Mostly involved is neural-muscle system. 2) This panel analyzes the sequence of 43 genes reported to be involved in the normal functioning of those complexes. Every nucleotide in the coding exons and immediate intronic sequences adjacent to intron-exon border will be examined. It is a diagnostic test for patients suspected with deficiency in any one of the five complexes, or combined deficiency with no clinical findings suggesting particular complex.
Test Details
Test Code:	2180
Special Notes:	All exons of these 43 genes are examined by NGS and Sanger Sequencing. Exonic variants and intronic variants within 20bp of the exon/intron boundary will be reported. This massively parallel sequence analysis (MitomeNGS) will not detect genomic structural rearrangements (eg. deletions, duplications, inversions, etc.), large insertion mutations (e.g. ALU mediated insertion, etc), mutations within the promoter or deep intronic regions. Mutations and novel variants are confirmed by Sanger sequencing. Sequence Analysis for the 43 genes in the Mitochondrial Respiratory Chain Complex I - V Deficiency Panel by Massively Parallel Sequencing (MitomeNGS) can be ordered separately: ATPAF2 (ATP12) , ATP5E (#3290), BCS1L (#3110), COX10 (#3100), COX15 (#3545), COX4I2, COX6B1,FASTKD2 (#3555), FOXRED1 (#2660), LRPPRC (#3240), NDUFA1 (#3485), NDUFA2 , NDUFA8, NDUFA10, NDUFA11 (#2680), NDUFA13, NDUFAF1 (#3940), NDUFAF2 (#3535), NDUFAF3 (#2690), NDUFAF4, NDUFAF5, NDUFS1 (#2700), NDUFS2 , NDUFS3 (#3570), NDUFS4 (#3560), NDUFS6 (#3565), NDUFS7, NDUFS8 (#3845), NDUFV1 (#3590), NUBPL (#2710), SCO1 (#3095), SCO2 (#3090),SDHA (#3180), SDHB (#3185), SDHC (#3190), SDHD (#3195), SDHAF1 (#3675), SURF1 (#3085), TACO1 (#2745), TMEM70 (#3735), TTC19 (#2715), UQCRB, and UQCRQ.
Technical Information
Methodology:	Targeted Capture followed by Massively Parallel Sequencing
Gene Name:	Please see "Test Details" section for a list of genes.

Sample & Shipping Information
Test Requisition:	Mitochondrial
Specimen Type:	Blood
Requirements:	Draw blood in an EDTA (purple-top) tube(s) and send 3-5 cc (Adults/Children).
Shipping Conditions:	Ship at room temperature in an insulated container by overnight courier. Do not heat or freeze. Sample must arrive within 72 hrs.
Specimen Type:	Purified DNA
Requirements:	Send at least 5ug of purified DNA (minimal concentration of 50ng/uL; A260/A280 of ~1.7).
Shipping Conditions:	Ship at room temperature in an insulated container by overnight courier. Do not heat or freeze.

Billing Information
Turn Around Time:	56 days
List Price:	$5,100.00 *Institutional discounts may apply, please call.
CPT Codes:	81404x1, 81405x2

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