Last Modified:
3/2/2011 9:56:20 AM
Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:
Tricyclic ABN Form: For acceptable narrative descriptions and ICD-9 information see Addendum C
Specimen Requirements:
1.0 mL Random Urine in a Plastic Container
Minimum Volume:
0.5 mL Urine
Transport & Storage: Temperature/Stability:
48 hours Refrigerated
Reference Range:
Negative
Methodology:
One-step Innunochromatographic
Custom Panel:
No
PRODUCTION SCHEDULE
Stat Eligible:
Yes
Days Performed:
Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed:
Parkview Regional Medical Center
PHL Test Code:
UTCAP
Alternate Test Names:
Tricyclic Urine
CPT Coding:
80101 (G0431 for Medicare)
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