test code: cpt code: 10000 87902 category: Infectious Disease HCV genotypes 1a CODON Simeprevir 1a Boceprevir 1a Telaprevir 1a Paritaprevir 1a Grazoprevir 1a V36A Comment R 3 R 10, 11 R 16 S 24 V36C V36G V36I V36L R 3 R 16 S 24 V36M R 3, 9 R 10, 11 R 16 S 24 Q41R R 3 F43I F43L R 5, 16 F43S F43V T54A R 3, 9 T54C T54G T54S R 3, 9 S 16 V55A R 3, 9 R 20 S 24 V55I S 3, 9, 20 S 20 S 16 Q80H Q80K R 1, 8, 22 S 8 S 8 R 5, 16 S 24 Q80L S 1 R 16 Q80R R 1, 22 R 16 S 24 V107I S 9 S122R R 1 S138T R155G R 5, 16 R155I R155K R 1, 22, 25 R 3, 9, 25 R 10, 11, 17, 25 R 5, 16 R 24, 25 R155L R155M R155Q R 25 R 25 R 25 R 25 R 25 R155S R 5, 16 R155T R 3 R 16
HCV genotypes 1a CODON Simeprevir 1a Boceprevir 1a Telaprevir 1a Paritaprevir 1a Grazoprevir 1a R155W R 16 A156F A156G R 25 R 25 R 25 R 25 R 25 A156N A156S S 25 R 3, 25 R 10, 11, 25 R 25 R 25 A156T R 17 R 5, 16 A156V V158I R 3, 9 D168A R 1, 25 S 25 S 17, 25 R 5, 16 25 R 24, 25 D168E R 1, 22 R 5, 16 R 24 D168F R 5 D168G R 24 D168H R 5, 16 D168I D168K D168N S 3 S 10, 11 R 5, 16 D168Q D168T D168V R 1 R 5, 16 D168Y R 5, 16 I170A I170M I170T * R 24 I170V R 9 M175L not applicable** *Low-grade or variable resistance. **Resistance to boceprevir has been noted in genotype 1b, however this substitution is not commonly found in genotype 1a. For the most up-to-date list of assays, please visit our website at www.viracor-eurofins.com. This test was developed and its performance characteristics determined by Viracor Eurofins. It has not been cleared or approved by the U.S. Food and Drug Administration. The CPT codes provided are based on Viracor Eurofins interpretation of the American Medical Association s Current Procedural Terminology (CPT) codes and are provided for informational purposes only. CPT coding is the sole responsibility of the billing party. Questions regarding coding should be addressed to your local Medicare carrier. Viracor Eurofins assumes no responsibility for billing errors due to reliance on the CPT codes illustrated in this material.
HCV genotypes 1b CODON Simeprevir 1b Boceprevir 1b Telaprevir 1b Paritaprevir 1b Grazoprevir 1a V36A R 12 R 2, 3, 10, 12 R 4, 6, 10, 11, 21 R 23 V36C S 10 R 10 V36G R 10, 19 R 6, 10, 11, 19, 21 V36I R 2 S 6, 10, 11 V36L S 12 S 10, 12 R 6, 10, 11, 12, 21 S 24 V36M R 10, 12 R 2, 3, 6, 9, 10 R 4, 6, 10, 11, 12, 18, 21 S 24 Q41R S 6, 12 R 2, 3 S 10 R 23 F43I R 6, 12 S 12 F43L F43S R 6, 12 R 2, 3, 6, 12 R 12 R 24 F43V R 6, 12 R 12 T54A S 10, 12 R 2, 3, 6, 9, 10, 12, 19 R 4, 6, 10, 11, 12, 18, 19, 21 S 16 T54C R 2 T54G R 3 T54S S 12 R 2, 3, 9, 12, 19 R 4, 6, 10, 11, 19 V55A R 2, 3, 9, 19 R 10, 19 S 16 S 24 V55I R 2, 3, 9 Q80H R 6, 12 S 12 Q80K R 1, 6, 12, 13, 22 S 2, 12 S 12 Q80L S 1, 22 S 12 Q80R R 1, 6, 12, 22 S 12 S 10, 12 R 24 V107I R 9 S122R R 1, 6, 13 S138T R 12 S 12 R155G R 12 R 10, 12 R 6, 10, 11, 12 R 24 R155I S 12 R 10, 12 R 10 R155K R 1, 6, 10, 12, 22 R 2, 3, 6, 9, 10, 12, 19 R 4, 6, 10, 12, 19 R 16 R or S* 23, 24, 25 R155L R 19 R 19 R155M S 12 R 10, 12 R 6, 10, 11, 12 R155Q S 12 S 12 R 12 R155S R 10 R 10 R155T R 12 R 2, 10, 12 R 4, 6, 10, 11, 12, 18 R155W A156F R 6, 10, 11 A156G R 6, 12 R 12 S 12 A156N R 6, 10, 11 A156S S 10, 12 R 2, 3, 6, 12, 19 R 4, 6, 11, 12, 14, 18, 19 S 16 A156T R 6, 10, 12 R 2, 3, 6, 10, 12, 19 R 4, 6, 11, 12, 15, 19 R 5, 16 R 23, 24 A156V R 6, 12 R 2, 3, 10, 12 R 4, 6, 11, 12, 15 V158I R 2, 3, 9 D168A R 1, 6, 12 S 12 S 12, 14 R 5, 16 R 24
HCV genotypes 1b CODON Simeprevir 1b Boceprevir 1b Telaprevir 1b Paritaprevir 1b Grazoprevir 1a D168E R 1, 6, 12, 22 S 12 S 12 R 16 R 24 D168F D168G R 12 S 12 R 24 D168H R 6, 12 S 12 S 12 R 5, 16 D168I R 6, 12 S 12 D168K R 24 D168N R 6, 12 S 12 S 6, 10, 12 D168Q R 13 D168T R 6, 12 S 12 S 12 R 16 D168V R 1, 6, 12 S 3, 12 S 14 R 5, 16 D168Y R 6, 12 R 12 S 12 R 16 R 23 I170A S 12 R 2, 3, 6, 10, 12, 19 R 10, 19 S 16 I170M R 3 I170T R 8, 12 R or S* 2, 8, 12 S 8 S 24 I170V S 13 M175L R 2, 3, 9 Comment: Patient genotype (1a/1b) displayed a mutation that has shown resistance to (drug name) in genotype (1a/1b). This test was developed and its performance characteristics determined by Viracor Eurofins. It has not been cleared or approved by the U.S. Food and Drug Administration. Results should be used in conjunction with clinical findings, and should not form the sole basis for a diagnosis or treatment decision. For the most up-to-date list of assays, please visit our website at Viracor-Eurofins.com. This test was developed and its performance characteristics determined by Viracor Eurofins. It has not been cleared or approved by the U.S. Food and Drug Administration. The CPT codes provided are based on Viracor Eurofins interpretation of the American Medical Association s Current Procedural Terminology (CPT) codes and are provided for informational purposes only. CPT coding is the sole responsibility of the billing party. Questions regarding coding should be addressed to your local Medicare carrier. Viracor Eurofins assumes no responsibility for billing errors due to reliance on the CPT codes illustrated in this material.
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