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Genetic Labs

Houston, Texas

Genetic Laboratory
Baylor Genetics Laboratories
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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.


Mitochondrial Nonsyndromic Hearing Loss and Deafness Mutation Panel
MT-TS1-Related Hearing Loss and Deafness | MTRNR1-Related Hearing Loss and Deafness (Aminoglycoside Ototoxicity) | Aminoglycoside Ototoxicity (MT-RNR1-Related) | Maternally Inherited Hearing Loss | mtDNA Nonsyndromic Hearing Loss Mutation Panel | Mitochondrial Sensorineural Hearing Loss and Deafness Mutation Panel
Test Information: Confirmation of Clinical Diagnosis, Risk Assessment - Positive Family History (no familial mutation known)

Test Details
Test Code: 3030
Test Includes: Full sequence analysis of the MT-RNR1, MT-TS1, MT-TS2 genes. This test will detect the common mutations in the MT-RNR1 gene, 1494C>T, 1555A>G and the common mutations found in the MT-TS1 gene, 7472insC, 7445A>G, 7510T>C, 7511T>C, 7512T>C.


Special Notes: If the mutation to be tested in this individual is one previously identified in an affected family member, please order test (#3031). Please see detailed requirements under this test code.

Sequence analysis does not detect low mutant heteroplasmy. Heteroplasmy <50% may not be detected.
Technical Information
Methodology: Sequence analysis is performed in both forward and reverse directions
Gene Name: MT-RNR1, MT-TS1, MT-TS2, MTRNR1
Protein Name: Mitochondrial 12S ribosomal RNA, Mitochondrial tRNA serine 1, Mitochondrially encoded tRNA serine 2 (AGU/C)
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) and 3 cc (Infant<2yrs).
Shipping Conditions: Ship at room temperature in an insulated container by overnight courier. Do not heat or freeze.

Specimen Type: Saliva
Requirements: Collected with Oragene DNA Self-Collection Kit (provided by MGL with instruction).
Shipping Conditions: Ship at room temperature in an insulated container by overnight courier. Do not heat or freeze.

Specimen Type: Skeletal Muscle
Requirements: 50 mg for muscle DNA analysis, 150mg for muscle ETC analysis, >200mg if additional tests are requested.
Shipping Conditions: Skeletal Muscle should be flash frozen in liquid nitrogen at collection with no media added, stored at -80C, and shipped by overnight courier on 3-5 lbs of dry ice.

Specimen Type: Tissue
Requirements: 50 mg of heart, brain, liver, kidney or fibroblast cultures for DNA analysis.
Shipping Conditions: Tissues such as liver and kidney should be flash frozen in liquid nitrogen at collection with no media added, stored at -80C, and shipped by overnight courier on 3-5 lbs of dry ice.

Turn Around Time: 21 days
Billing Information
List Price: *For Insurance or Institutional Prices, please call.
CPT Codes: 81401x2


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