Hepatitis C Virus (HCV) FibroSure®

Last Modified: 6/3/2019 7:41:46 AM


  Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:  
Client Notes:  
Patient Preparation: Overnight Fasting preferred
Specimen Requirements: 3.0 mL Serum from a Red Top Tube
Collection Instructions: Separate serum from cells within 15-30 minutes of Collection
Transport & Storage: Temperature/Stability:

24 hours Ambient
5 days Refrigerated
5 days Frozen (Transport)

Rejection Criteria: Gross hemolysis and/or lipemia; Patient < 2 years old; QNS for one or more analytes
Reference Range:

Refer to Interprative Results

Critical Ranges:  
Test Comments:  
Methodology: Nephelometry; Spectrophotometry (SP); Immunoassay
Clinical Significance:

FibroTest and ActiTest permit the non-invasive evaluation of Hepatitis C (or B) individuals for the presence of liver fibrosis and liver inflammation, respectively. The FibroTest and ActiTest scores are calculated based on patient age, gender and concentrations of serum of y-glyutamyl transferase (GGT), total bilirubin (TB), a-2 macroglobulin, haptoglobulin, apolipoprotein A1 and alanine aminotransferase (ActiTest). Fibrotest adn ActiTest Scores, on a scale of 0.0 to 1.0 are assigned a Metavir scale indicating the level fo fibrosis or inflammation present.

Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Days Performed: Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Quest - Chantilly to San Juan Capistrano
PHL Test Code: ACTI
EPIC Test Code: LAB2923
Send Out Test Code: 92688
Alternate Test Names: ActiTest; FibroSURE® HCV; FibroTest; FibroTest-ActiTest Panel; HCV FibroSURE®; LIver Fibrosis; Liver Fibrosis, FibroTest-ActiTest Panel; Was: HCV FibroSure
Included Tests: Alanine Aminotransferase (ALT); Alpha-2-Macroglobin; Apolipoprotein A1; Bilirubin, Total; Gamma Glutamyl Transferase (GGT); Haptoglobin; Fibrosis Score; Necroinflammat Act Score
CPT Coding: 81596

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