TEST MENU TEST CPT CODES TAT. Chromosome Analysis Bone Marrow x 2, 88264, x 3, Days
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1 TEST MENU CANCER/LEUKEMIA CHROMOSOME ANALYSIS Chromosome Analysis Bone Marrow x 2, 88264, x 3, Days Chromosome Analysis Bone Marrow Core x 2, 88264, x 3, Days Chromosome Analysis Leukemic Blood x 2, 88264, x 3, Days Chromosome Analysis Lymph Node x 2, 88264, x 3, Days Chromosome Analysis Mass/Solid Tumor x 2, 88264, x 3, Days Chromosome Analysis Peritoneal Fluid x 2, 88264, x 3, Days Chromosome Analysis Pleural Fluid x 2, 88264, x 3, Days Chromosome Analysis Fixed Pellet 88264, x 3, Days Chromosome Analysis Fine Needle Aspirate x 1, 88264, x 3, Days FLUORESCENCE IN SITU HYBRIDIZATION (FISH) FISH - Single (Whole Specimen or Pellet) (per probe), (per probe), Days FISH Single (Paraffin Embedded Tissue Slides) (per probe), (per probe), Days FISH Multi - (Whole Specimen or Pellet) x 2 (per probe), (per probe), Days FISH Multi - (Paraffin Embedded Tissue Slides) (per probe), (per probe), Days FISHnet / ifish (enrichment only) (FISH codes will also apply see above) 4 Days (See below for list of FISH probes by profile and in numerical order.) (FISH may be performed on the following specimen types: Bone Marrow, Bone Marrow Core, Leukemic Blood, Lymph Node, Mass/Solid Tumor, Paraffin Embedded Tissue Slides, Pleural Fluid, and Peritoneal Fluid.)
2 FISH PROBES BY PROFILE Adult B-Cell ALL profile del(9p) CDKN2A del(6q) CCND3/SEC63/MYB t(9;22) BCR/ABL1/ASS1 11q23 KMT2A (MLL) rearrangements t(1;19) TCF3/PBX1 14q32 IGH rearrangements Adult T-Cell ALL profile 14q11.2 TRA rearrangements 7q34 TRB rearrangements 10q24 TKX1 5q35 TLX3 11q23 KMT2A (MLL) rearrangements del(9p) CDKN2A Pediatric ALL profile (COG) t(12;21) ETV6/RUNX1 11q23 KMT2A (MLL) rearrangements t(9;22) BCR/ABL1/ASS1 trisomy 4,10,17 14q32 IGH rearrangement Additional probes t(1;19) TCF3/PBX1 Ph-Like ALL profile 1q25.2 ABL2 5q32 PDGFRb 5q32 CSF1R 9p24.1 JAK2 9q34.1 ABL1 19p13.2 EPOR Xp22.33/Yp11.3 CRFL2 Acute Myelogenous (AML) profile t(15;17) PML/RARA t(9;22) BCR/ABL1/ASS1 CLL Lymphocytic (CLL) profile (CD19+ Clones Available) del(11q) ATM t(8;21) RUNX1T1/RUNX1 trisomy 12 11q23 KMT2A (MLL) rearrangements inv(16), t(16;16) CBFB rearrangements inv(3) MECOM rearrangements 17q RARA rearrangements NUP98 11p15 del(13q) 13q14/13q34 del(17p) TP53 Additional Probes t(11;14) CCND1/IGH del(6q) CCND3/SEC63/MYB
3 Chronic Myelogenous (CML) profile t(9;22) BCR/ABL1/ASS1 Additional probes trisomy 8 i(17q) Lymphoma probes (CD19+ Clones Available) t(8;14) MYC/IGH (Burkitt or Follicular) 8q24 MYC rearrangements t(11;14) CCND1/IGH (Mantle Cell) t(11;18) BIRC3/MALT1 18q21 BCL2 rearrangements 18q21 MALT1 rearrangements t(14;18) IGH/BCL2 (Follicular or Diffuse Large B-Cell) 3q27 BCL6 rearrangements (Diffuse Large B-Cell, Follicular Marginal Zone B-cell) T-cell Leukemia/Lymphoma probes 2p23 ALK (Anaplastic) rearrangements Multiple Myeloma CD138 Enriched (MM) profile (FISHnet ) 1p32.3/1q21 CDKN2C/CKS1B 14q11.2 TRA rearrangements del(13q) 13q14/13q34 7q34 TRB rearrangements i(7q) 7cen/7q22/7q31 14q32 TCL1A 10q24 TLX1 5q35 TLX3 del(17p) TP53 t(11;14) CCND1/IGH t(4;14) FGFR3/IGH t(14;16) IGH/MAF Additional probes trisomy 5 8q24 MYC rearrangements t(6;14) CCND3/IGH t(14;20) IGH/MAFB
4 Myelodysplastic (MDS) profile del(5q) EGR1 Myeloproliferative (MPN) profile del(5q) EGR1 del(7q) / monosomy 7 del(7q) / monosomy 7 trisomy 8 trisomy 8 del(20q) Additional probes 11q23 KMT2A (MLL) rearrangements t(9;22) BCR/ABL1/ASS1 NUP98 11p15 del(20q) t(9;22) BCR/ABL1/ASS1 Additional probes 4q12 FIP1L1/CHIC2/PDGFRA 5q33 PDGFRB rearrangements 8p11 FGFR1 rearrangements 9q24 JAK2 rearrangements Solid Tumor probes EWSR1 Ewing Sarcoma Transplant XX/XY for sex mismatched transplants FOXO1 Alveolar Rhabdomyosarcoma DDIT3 (CHOP) Myxoid Liposarcoma LOH 1p/19q Glioma MYCN 2p24.1 Neuroblastoma SS18 Synovial Sarcoma Bladder Cancer Screening (Trisomy 3, 7, 17, & 9p21 loss)
5 FISH PROBES NUMERICALLY Chromosome # Probe Location on Cancer Requisition 1 1p32.3/1q21 CDKN2C/CKS1B Multiple Myeloma Profile 1 1q25.2 ABL2 Ph Like ALL profile 1, 19 t(1;19) TCF3/PBX1 Adult B-Cell ALL profile Pediatric ALL profile 1, 19 1p/19q LOH (Glioma) Solid Tumor probes 2 2p23 ALK (Anaplastic) rearrangements T-cell Leukemia/Lymphoma probes 2 2p24.1 MYCN (Neuroblastoma) Solid Tumor probes 3 inv(3) MECOM rearrangements Acute Myelogenous (AML) profile 3 3q27 BCL6 rearrangements (Diffuse Large B-Cell, Follicular, Marginal Zone B-cell) Lymphoma probes 4, 10, 17 trisomy 4,10,17 Pediatric ALL profile 4 4q12 FIP1L1/CHIC2/PDGFRA Myeloproliferative (MPN) profile 4, 14 t(4;14) FGFR3/IGH Multiple Myeloma Profile 5 del(5q) EGR1 / trisomy 5 Multiple Myeloma Profile Myeloproliferative (MPN) profile Myelodysplastic (MDS) profile 5 5q33 PDGFRB rearrangements Multiple Myeloma Profile Ph Like ALL Profile 5 5q32 CSF1R Ph Like ALL Profile 5 5q35 TLX3 Adult T-Cell ALL profile
6 Chromosome # Probe Location on Cancer Requisition 6 del(6q) CCND3/SEC63/MYB Adult B-Cell ALL profile Chronic Lymphocytic (CLL) profile 6, 14 t(6;14) CCND3/IGH Multiple Myeloma Profile 7 del(7q) / monosomy 7 / trisomy 7 Multiple Myeloma Profile Myelodysplastic (MDS) profile Myeloproliferative (MPN) profile 7 i(7q) 7cen/7q22/7q31 T-cell Leukemia/Lymphoma probes 7 7q34 TRB rearrangements Adult T-Cell ALL profile T-cell Leukemia/Lymphoma probes 8 trisomy 8 (CHARGE) Chronic Myelogenous (CML) profile Myelodysplastic (MDS) profile Myeloproliferative (MPN) profile 8 8p11 FGFR1 rearrangements Myeloproliferative (MPN) profile 8 8q24 MYC rearrangements Lymphoma probes 8,14 t(8;14) MYC/IGH (Burkitt or Follicular) Lymphoma probes 8, 21 t(8;21) RUNX1T1/RUNX1 Acute Myelogenous (AML) profile 9 9q24 JAK2 rearrangements Myeloproliferative (MPN) profile 9 del(9p) CDKN2A Adult B-Cell ALL profile Adult T-Cell ALL profile 9 9q34.1 ABL1 Ph Like ALL Profile
7 Chromosome # Probe Location on Cancer Requisition 9, 22 t(9;22) BCR/ABL1/ASS1 Adult B-Cell ALL profile Pediatric ALL profile Acute Myelogenous (AML) profile Chronic Myelogenous (CML) profile Myelodysplastic (MDS) profile Myeloproliferative (MPN) profile 10 10q24 TLX1 Adult T-Cell ALL profile T-cell Leukemia/Lymphoma probes 11 NUP98 11p15 Acute Myelogenous (AML) profile Myelodysplastic (MDS) profile 11 del(11q) ATM Chronic Lymphocytic (CLL) profile 11 11q23 KMT2A (MLL) rearrangements Myelodysplastic (MDS) profile Adult B-Cell ALL profile Adult T-Cell ALL profile Pediatric ALL profile Acute Myelogenous (AML) profile 11, 14 t(11;14) CCND1/IGH Chronic Lymphocytic (CLL) profile t(11;14) CCND1/IGH (Mantle Cell) t(11;14) CCND1/IGH Lymphoma probes Multiple Myeloma Profile 11, 18 t(11;18) BIRC3/MALT1 Lymphoma probes 12 trisomy 12 Chronic Lymphocytic (CLL) profile 12 12q13 DDIT3 (CHOP) Myxoid Liposarcoma Solid Tumor probes 12, 21 t(12;21) ETV6/RUNX1 Pediatric ALL profile
8 Chromosome # Probe Location on Cancer Requisition 13 del(13q) 13q14/13q34 Chronic Lymphocytic (CLL) profile Multiple Myeloma Profile 13 13q14.1 FOXO1 Alveolar Rhabdomyosarcoma Solid Tumor probes 14 14q11.2 TRA rearrangements Adult T-Cell ALL profile T-cell Leukemia/Lymphoma probes 14 14q32 IGH rearrangements Adult B-Cell ALL profile Pediatric ALL profile 14 14q32 TCL1A T-cell Leukemia/Lymphoma probes 14, 16 t(14;16) IGH/MAF Multiple Myeloma Profile 14, 18 t(14;18) IGH/BCL2 (Follicular or Diffuse Large B-Cell) Lymphoma probes 14, 20 t(14;20) IGH/MAFB Multiple Myeloma Profile 15, 17 t(15;17) PML/RARA Acute Myelogenous (AML) profile 16 inv(16), t(16;16) CBFB rearrangements Acute Myelogenous (AML) profile 17 del(17p) TP53 Chronic Lymphocytic (CLL) profile del(17p) TP53 Multiple Myeloma Profile 17 i(17q) Chronic Myelogenous (CML) profile 17 17q RARA rearrangements Acute Myelogenous (AML) profile 18 18q11.2 SS18 Synovial Sarcoma Solid Tumor probes 18 18q21 BCL2 rearrangements Lymphoma probes 18 18q21 MALT1 rearrangements Lymphoma probes 19 19p13.2 EPOR Ph Like Profile 20 del(20q) Myelodysplastic (MDS) profile Myeloproliferative (MPN) profile
9 Chromosome # Probe Location on Cancer Requisition 22 22q12.2 EWSR1 Ewing Sarcoma Solid Tumor probes 3, 7, 9, 17 Bladder Cancer Screening Solid Tumor probes X/Y CEPXY (XX/XY for sex mismatched transplant) Transplant X/Y Xp22.33/Yp11.3 CRFL2 Ph Like ALL Profile CHROMOSOME MICROARRAY Microarray (SNP) Days NEXT GENERATION SEQUENCING (NGS) NGS Days (See below for list of NGS panels.) Panel AML Molecular Profile MDS Molecular Profile MPN Molecular Profile MPN Targeted Molecular Profile Myeloid Complete Molecular Profile Included Genes ASXL1, CBL, CEBPA, CSF3R, DNMT3A, EZH2, IDH1, IDH2, JAK2, KIT, MPL, NPM1, NRAS, RUNX1, SETBP1, SF3B1, SRSF2, TET2, TP53, U2AF1 ASXL1, EZH2, DNMT3A, RUNX1, SF3B1, SRSF2, TET2, TP53, U2AF1 ABL1, CALR, CSF3R, EZH2, JAK2, MPL, SETBP1 JAK2, MPL, CALR ABL1, ASXL1, BRAF, CALR, CBL, CEBPA, CSF3R, DNMT3A, EZH2, IDH1, IDH2, JAK2, KIT, KRAS, MPL, NPM1, NRAS, RUNX1, SETBP1, SF3B1, SRSF2, TET2, TP53, U2AF1
10 POLYMERASE CHAIN REACTION (PCR) BCR/ABL p210 BKPT Days BCR/ABL p190 BKPT Days FLT3 Mutation Detection 81245, Days IgVH Hypermutation Analysis Days JAK Days T-Cell Clonality Assessment 81340, Days B-Cell Clonality Assessment 81264, Days
11 CONSTITUTIONAL / PRENATAL CHROMOSOME ANALYSIS Chromosome Analysis Amniotic Fluid X 2, 88267, 88261, 88280, Days Chromosome Analysis CVS X 2, 88267, 88261, 88280, 88172, Days Chromosome Analysis Newborn Peripheral Blood x 2, 88262, 88280, Days Prelim 48 hours Chromosome Analysis Peripheral Blood x 2, 88262, 88280, Days Chromosome Analysis POC 88305, 88233x2, 88261, 88267, Days Chromosome Analysis Tissue x 2, 88264, x 3, Days CHROMOSOME MICROARRAY Microarray (SNP) Days FLUORESCENCE IN SITU HYBRIDIZATION (FISH) FISH (Microdeletion) 88271, 88273, Days AneuVysion FISH Amniotic Fluid x 5, 88275, hours AneuVysion FISH Paraffin Embedded Slides x 5, 88275, Days POC FISH Product of Conception Tissue x 8, X 2, Days POC FISH Paraffin Embedded Slides x 8, X 2, Days (See below for list of FISH probes by profile and in numerical order.) (FISH may be performed on the following specimen types: Bone Marrow, Bone Marrow Core, Leukemic Blood, Lymph Node, Mass/Solid Tumor, Paraffin Embedded Tissue Slides, Pleural Fluid, and Peritoneal Fluid.)
12 CONSTITUTIONAL / PRENATAL FISH PROBES BY PROFILE Microdeletion Syndromes Angelman (15q12) Cri-du-Chat (5p15.3) DiGeorge (22q11.2) Other Trisomy 13 Patau Syndrome Trisomy 18 Edwards Syndrome Trisomy 21 Down Syndrome DiGeorge II (10p14) Kallman (Xp22.3) Panels 1p36 microdeletion AneuVysion (X, Y, 13, 18, 21) Miller-Dieker (17p13.3) POC FISH (X, Y, 13, 15, 16, 18, 21, 22) Pallister-Killian/Tetrasomy 12p Phelan-McDermid (22q13) Prader-Willi (15q12) Saethre-Chotzen (7p21.1) Sex Chromosome Abnormalities X/SRY (Sex Determination) CEPX/CEPY (Turner Syndrome) Smith-Magenis (17p11.2) Sotos (5q35.3) Steroid Sulfatase Deficiency (Xp22.3) Williams (7q11.23) Wolf-Hirschhorn (4p16.3)
13 CONSTITUTIONAL / PRENATAL FISH PROBES NUMERICALLY by CHROMOSOME Chromosome # Probe 1 1p36 microdeletion 4 Wolf-Hirschhorn (4p16.3) 5 Cri-du-Chat (5p15.3) 5 Sotos (5q35.3) 7 Saethre-Chotzen (7p21.1) 7 Williams (7q11.23) 10 DiGeorge II (10p14) 12 Pallister-Killian/Tetrasomy 12p 13 Trisomy 13 Patau Syndrome 15 Angelman (15q12) 15 Prader-Willi (15q12) 17 Miller-Dieker (17p13.3) 18 Trisomy 18 Edwards Syndrome 21 Trisomy 21 Down Syndrome 22 DiGeorge (22q11.2) 22 Phelan-McDermid (22q13) X Kallman (Xp22.3) X Steroid Sulfatase Deficiency (Xp22.3) X/SRY X/SRY - Sex Determination CEPX/CEPY CEPX/CEPY - Turner Syndrome Panels X,Y,13,18,21 AneuVysion X,Y,13,15,16,18,21,22 POC FISH
14 CONSTITUTIONAL / PRENATAL POLYMERASE CHAIN REACTION (PCR) Thrombophilia Panel (Factor II, Factor V, MTHFR) 81240, 81241, Days ADDITIONAL SENDOUT TESTING Cystic Fibrosis Days Fragile X 81243, Days AZF-Y Microdeletion Days
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