Chromosomal Microarray

Last Modified: 2/20/2019 12:42:32 PM


Medical Necessity Documentation:  
Client Notes:

All insurance information must be filled out on the requisition

Pre-Authorization is required for this testing. 

Due to specimen stability, if Pre-Authorization is not with the patient at time of collection a recollect may need to be done once pre-authorization is obtained.

Patient Preparation:  
Specimen Requirements: 5.0 mL Whole Blood in two (2) Green Top Tubes - Na Heparin
Collection Instructions:  
Minimum Volume: 3.0 mL Whole Blood
Neonatal Volume: 0.5 mL Whole Blood
Transport & Storage: Temperature/Stability:

When collected Monday thru Thursday - Ambient 
When collected Friday thru Sunday - Refrigerated

*Note Samples are best if received by Quest within 72 hours.

Unacceptable - Frozen

Rejection Criteria: Frozen
Reference Range: Refer to Interpretive Results
Critical Ranges:  
Test Comments:

If results are not possible, the test order may be canceled and replaced by code 416-Cytogenetics Communication

Methodology: Oligo-SNP Array
Clinical Significance:

Determine genetic cause of developmental delay (DD) or mental retardation (MR) in patients with or without dysmorphic features.

Confirm, exclude, (or clarify) the diagnosis of known chromosomal syndromes.

Assist in clinical management and genetic counseling.

High resolution detection of chromosome segments involved in deletions, duplications, and long continuous stretches of homozygosity.

Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Turn Around Time: 12 to 19 days
Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday
Sites Performed: Quest - Chantilly
PHL Test Code: MIARX
EPIC Test Code: LAB2577
Send Out Test Code: 16478
Alternate Test Names: Array Genomic Alterations; Autism Genomic Alterations; Birth Defects Genomic Alterations; Chromosomal Microarray, Postnatal, ClariSure® Olig; ClariSure® Genomic Alterations; ClariSure® Oligo-SNP Array; Congenital Malformations; Constitutional Abnormality; Developmental Delay; Mental Retardation; Microarray Genomic Alterations; Oligo-SNP Array Genomic Alteration; Oligo-SNP Microarray; Postnatal; Subtelomere
Included Tests:  
CPT Coding: 81229

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