ALLERGEN PANEL, DAIRY AND GRAIN, SERUM

Additional Codes

Software	Test Code
Label Text	DGAP
EPIC	LAB645

Performing Laboratory

NorDx Laboratories

Useful For

Establishing the diagnosis of an allergic disease and defining the allergens responsible for eliciting signs and symptoms

If an IgE, Total is desired, please order individually “IGET”.

Method Name

ImmunoCAP® Fluorescence Enzyme Immunoassay (FEIA)

Reference Values

< 0.10 kU/L : Undetectable (Normal)

0.10-0.34 kU/L: For specialist use only:Clinical Relevance Undetermined

0.35-0.69 kU/L: Low level of allergy, indicative of ongoing sensitization

0.70-3.49 kU/L: Moderate level of allergy, indicative of stronger ongoing sensitization

3.5-17.49 kU/L: High level of allergy, indicative of high level sensitization

17.5-49.9 kU/L: Very high level of allergy, indicative of very high level sensitization

50-99.9 kU/L: Very high level of allergy, indicative of very high level sensitization

≥ 100 kU/L: Very high level of allergy, indicative of very high sensitization

CONCENTRATION (kU/L) RESULTS EQUIVALENT TO ALTERNATIVE SCORING METHOD:

CLASS 0: <0.22

CLASS 0/1: 0.22-0.31

CLASS 1: 0.31-0.55

CLASS 2: 0.55-1.4

CLASS 3: 1.4-3.9

CLASS 4: 3.9-19

CLASS 5: 19-100

CLASS 6: >100100

Days and Times Test Performed

Monday through Friday

Report Available

1 Day

Profile Information

Individual Test Description
EGG WHITE IGE
MILK, COW IGE
OAT IGE
SOYBEAN IGE
WHEAT IGE

Specimen Type

Serum

Preferred Container

Serum Separator Tube (SST)

Preferred Volume

Serum: 2 mL (Serum Separator Tube (SST))

Minimum Volume

Serum: 1.5 mL (Serum Separator Tube (SST))

Specimen Collection and Handling

Spin specimen, separate from clot and send refrigerated.

Specimen Stability Information

Specimen Type: Serum

Frozen: 3 Months

Refrigerated: 7 Days

Must be spun/separated within: 2 Hours

Note: Avoid freeze/thaw cycles

Add On Capable

Yes

Advance Beneficiary Notice Requirements

This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. The CMS web site is available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD code chosen.

CPT Code Information

CPT Code	CPT Description	CPT Disclaimer
86003 x5	Allergen Specific IgE, Quantitative or Semiquantitative, Crude Allergen Extract, Each

Keywords

ALLERGENS

Performing Laboratory Location