Prostate Specific Antigen with Free PSA Reflex

Last Modified: 8/21/2023 2:58:45 PM


  Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:
Client Notes:  
Patient Preparation: Patient should discontinue taking Biotin, Vitamin B7, or Vitamin H 48 hours before getting blood drawn.
Specimen Requirements: 1.0 mL Serum in a SST Gold Top Tube
Collection Instructions:  
Transport & Storage: Temperature/Stability: 48 hours Refrigerated
> 48 hours Frozen
Reference Range: 0.0 - 4.0 ng/mL
Critical Ranges:  
Test Comments:

A Free PSA will be ordered and charged when the PSA results are > 4.0 or <10.0.

Patients taking vitamin supplements containing doses of >5 mg/day may have falsely decreased test results generated.

Methodology: Chemiluminescence ECLIA
Clinical Significance:  
Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Parkview Regional Medical Center
PHL Test Code: PSAR
EPIC Test Code: LAB2313
Alternate Test Names: PSA Free if indicated; PSA with Free PSA Reflex
Included Tests:  
CPT Coding: 84153 (Reflexes 84154)

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