Last Modified:
8/21/2023 2:01:13 PM
Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:
Client Notes:
Patient Preparation:
Specimen Requirements:
1.0 mL Plasma from a PST Mint Green Top Tube - Lithium Heparin (preferred)
or
1.0 mL Serum in a SST Gold Top Tube
Collection Instructions:
Minimum Volume:
0.2 mL
Transport & Storage: Temperature/Stability:
4 days Refrigerated
24 hours unspun
Reference Range:
1 day to 8 days: 12.4 - 24.0 ug/dL
8 days to 1 month: 8.2 - 16.6 ug/dL
1 month to 1 year: 7.2 - 15.6 ug/dL
Male 1 year and older: 4.5 - 12.1 ug/dL
Female 1 year and older: 4.8 - 13.9 ug/dL
Critical Ranges:
Test Comments:
This assay utilizes biotin technology. Patients taking vitamin supplements containing high doses of biotin (>5 mg/day) may have falsely increased test results generated.
Methodology:
Enzyme Emit Homogenous Immunoassay
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:
T4
EPIC Test Code:
LAB126
Alternate Test Names:
T4; T4 Total; Thyroxine (T4)
Included Tests:
CPT Coding:
84436
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