Test Code CYCSCR CYCLOSPORINE DRUG SCREEN PANEL, BLOOD

Important Note

Test subject to Medicare National Coverage Determination (NCD) Cardiovascular Screening Blood Tests . and 190.23 - Lipids Testing. Fasting specimen preferred. Test includes potassium, BUN, Creatinine, Total Bilirubin, AST, ALT, Uric Acid, Magnesium and Cholesterol.

When ordering a custom panel, Medicare requires the clinician confirm each test in the panel is medically necessary for the patient’s treatment. By regulation, annually we will send a physician acknowledgement letter to ordering clinicians requesting a signature attesting to medical necessity review.

Additional Codes

Primary ID	Epic Code	Mayo Access ID
CYCSCR	LAB3640	N/A

Specimen Information

Container	Specimen	Temperature	Collect Vol	Submit Vol	Minimum Vol	Stability
Serum Separator Tube	Serum	Refrigerate	4 mL	1 mL	1 mL

Fasting specimen preferred. Lithium heparin (green top) plasma acceptable.

Test Schedule / Analytical Time / Test Priority

Daily / 1 day / Not Available STAT

Method

Colorimetric Reflectance Spectrophotometry

CPT(s)

Description	CPT Code
Triglyceride	84478

Instrumentation

Ortho Vitros

Reference Range

See individual tests.

Section

Chemistry-1

Performing Location

University of Vermont Medical Center

Is the UVMMC lab NY State Certified to perform this testing? Yes/No

Yes

LOINC Code Information