Geisinger Medical Laboratories/Geisinger Proven Diagnostics Test Catalog

ENCEPHALITIS ANTIBODY EVALUATION WITH REFLEX TO TITER AND LINE BLOT, CSF

1. A line blot consisting of 10 analytes will be performed at an additional charge (CPT code(s): 84182 x9, 86341) as a reflex for tissue mosaic IFA suggesting one or more of the analytes on the line blot: ANNA1 (Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CV2 (CRMP5), Amphiphysin, AGNA1 (SOX1), GAD65, DNER, and Zic4. If the tissue mosaic pattern suggests ANNA3, titer will be performed at an additional charge (CPT code(s): 86256).
2. If the tissue mosaic pattern suggests PCA-2, titer will be performed at an additional charge (CPT code(s): 86256).
3. If the tissue mosaic IFA suggests PCA-Tr (DNER) and Western Blot shows DNER negative and Yo negative, then cell based assay IFA for DNER will be performed at an additional charge (CPT code(s): 86255).
   a. If DNER CBA is positive, titer will be performed at an additional charge (CPT code(s): 86256).
4. If the tissue mosaic IFA suggests myelin antibody, then
   a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256).
   b. Myelin Associated Glycoprotein (MAG) Antibody Western Blot (CPT code(s): 84182), in turn reflexing to MAG-SGPG and MAG ELISA for quantitation, will be performed at an additional charge (CPT code(s): 83520 x2).
5. If the Mosaic CBA is positive for any given analyte (NMDAR1, AMPAR1, AMPAR2, GABA-B Receptor, LGI-1, CASPR2), and the individual CBAs DPPX and Aquaporin 4 antibody, then that analyte will be titered at an additional charge (CPT code(s): 86256 for each titer performed).
6. If DPPX is positive, titer will be performed at an additional charge (CPT code(s): 86256).
7. If the Aquaporin 4 (NMO, neuromyelitis optica) CBA is positive, then Aquaporin 4 CBA titer will be performed at an additional charge (CPT code(s): 86256).