| This test may reflex to additional tests depending upon the results of this test. An additional fee will be added if the reflex test is necessary. |
| This test is a lab developed test. For further information, see the Compliance Remarks section below. |
| SPECIMEN REQUIREMENTS | | | Container Type | Random urine | | Supply Item Number | 1387 | | Specimen Type | Random urine | | Preferred Volume | 30 mL | | Emergency Minimum Volume | 15 mL | | Collection Procedure | Collect a random urine in a leakproof plastic urine container. | | Store and Transport | Ambient (room temperature) | | Stability | Room Temp 10 days Refrigerated 1 month | | Reference Laboratory | PAML | | Reference Lab Test Code | LCA code 911053 | | CPT Codes | 80307 | | Interface Order Code | 80100.Z201 | | Billing Code | DA4001 | | Test Schedule | Mon-Sat | | Turnaround Time | 1-3 days | | Method | Enzyme Immunoassay | | Reference Ranges | | Title | Descriptor | Ranges | Units | | Urine Creatinine | Normal | > 19 | mg/dL | | Urine pH | Normal | 4.5-9.0 | | Glucose | Negative | < 20 | mg/dL | | Urine Specific Gravity | Normal | 1.003-1.020 | | Phencyclidine (PCP) Screen | Negative | < 25 | ng/mL | | Ecstasy Screen | Negative | < 500 | ng/mL | | Barbiturates Screen | Negative | < 200 | ng/mL | | Cannabinoid Screen | Negative | < 50 | ng/mL | | Methadone (EDDP) Screen | Negative | < 100 | ng/mL | | Amphetamines Screen | Negative | < 500 | ng/mL | | Benzodiazepines Screen | Negative | < 200 | ng/mL | | Cocaine (BEG) Screen | Negative | < 150 | ng/mL | | Opiates Screen | Negative | < 300 | ng/mL | | Oxycodone Screen | Negative | < 100 | ng/mL | | 6MAM Screen | Negative | < 10 | ng/mL | | Propoxyphene Screen | Negative | < 300 | ng/mL | | Ethanol Screen | Negative | < 20 | mg/dL |
| | Compliance Remarks | This test was developed and its performance characteristics determined by PAML. The U.S. Food and Drug Administration (FDA) has not approved or cleared this test. However, FDA approval or clearance is currently not required for clinical use of this test. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions. PAML is authorized under Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity testing. | | Notes | The DA4001 offers a qualitative screen and quantitative confirmation for the licit and illicit drugs listed above. | | Reflex Testing | | Reflex Condition | Reflex Test Name | Reflex CPT codes | Reflex Billing codes | | Cannabinoid Screen Positive | MSTHC | 80349 | BMSTHC | | Cocaine Screen Positive | MSCOC | 80353 | BMSCOC | | Amphetamines Screen Positive | MSAPX | 80324, 80359 | BMSAPX | | Opiates Screen Positive | LCOP9 | 80356, 80365, 80361 | BLCOP9 | | Oxycodone Screen Positive | LCOP9 | 80356, 80365, 80361 | BLCOP9 | | Benzodiazepines Screen Positive | BENZLC | 80347 | BBENZL | | Phencyclidine (PCP) Screen Positive | MSPCP | 83992 | BMSPCP | | Ecstasy (MDMA) Screen Positive | MSAPX | 80324, 80359 | BMSAPX | | Barbiturates Screen Positive | MSBAR | 80345 | BMSBAR | | Propoxyphene Screen Positive | MSPRO | 80367 | BMSPRO | | Ethanol Screen Positive | GCALC | 80320 | BALC | | Methadone Screen Positive | MSMET | 80358 | BMSMET | | 6MAM Screen Positive | LCOP9 | 80356, 80365, 80361 | BLCOP9 |
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| Interface Codes | | type | order code | test description | result code | result description | units | decimal places | loinc code | | o | 80100.Z201 | Drugs of Abuse 4001 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80100.Z162 | Ecstasy (MDMA,MDEA,MDA) Screen | ng/mL | | 73971-4 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80100.Z163 | MDEA (GCMS) | ng/mL | | 27085-0 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80100.Z168 | Noroxycodone (LCMSMS) | ng/mL | | 61423-0 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80100.Z169 | Norhydrocodone (LCMSMS) | ng/mL | | 61420-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80100.Z179 | Toxicology Glucose | mg/dL | | | | r | 80100.Z201 | Drugs of Abuse 4001 | 80100.Z180 | Yeast | | | | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z17 | Methadone Rflx | ng/mL | | 70149-0 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z21 | Phencyclidine Screen | ng/mL | | 3937-0 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z24 | Ethanol, Urine | mg/dL | | 42242-8 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z25 | Opiate Screen | ng/mL | | 8220-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z29 | Propoxyphene Rflx | ng/mL | | 19429-0 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z31 | Amphet/Methamphet Screen | ng/mL | | 43983-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z36 | Benzodiazepine Screen | ng/mL | | 70141-7 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z37 | Barbiturates Screen | ng/mL | | 70155-7 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z55 | MDMA (GCMS) | ng/mL | 0 | 18358-2 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z56 | MDA (GCMS) | ng/mL | | 20545-0 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z6 | Cannabinoid Screen | ng/mL | | 70145-8 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z65 | 6 MAM Screen | ng/mL | 0 | 19321-9 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z66 | Oxycodone Screen | ng/mL | 0 | 19642-8 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80101.Z8 | Cocaine Screen | ng/mL | | 43984-4 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z109 | 6 MAM (Heroin Metabolite) (LCMSMS) | ng/mL | | 19593-3 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z11 | Amphetamine (GCMS) | ng/mL | | 20410-7 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z12 | Methamphetamine (GCMS) | ng/mL | | 16235-4 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z14 | Amobarbital (GCMS) | ng/mL | | 16239-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z15 | Butalbital (GCMS) | ng/mL | | 16237-0 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z16 | Pentobarbital (GCMS) | ng/mL | | 16240-4 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z164 | 7-Aminoflunitrazepam (LCMSMS) | ng/mL | | 51777-1 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z17 | Phenobarbital (GCMS) | ng/mL | | 16241-2 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z18 | Secobarbital (GCMS) | ng/mL | | 16238-8 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z26 | Cocaine Metab (GCMS) | ng/mL | | 53743-1 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z29 | Methadone Metab. by GC/MS | ng/mL | | 58429-2 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z33 | Phencyclidine (GCMS) | ng/mL | | 16254-5 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z36 | Norpropoxyphene by GC/MS | ng/mL | | 17377-3 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z38 | Carboxy-THC (GCMS) | ng/mL | | 20521-1 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z60 | Urine Alcohol (GC) | mg/dL | | 5645-7 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z76 | Clonazepam (LCMSMS) | ng/mL | | 16229-7 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z78 | Flunitrazepam (LCMSMS) | ng/mL | 1 | 20528-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z81 | Morphine (LCMSMS) | ng/ml | | 16251-1 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z82 | Oxymorphone (LCMSMS) | ng/ml | | 17395-5 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z83 | Hydromorphone (LCMSMS) | ng/ml | | 16998-7 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z84 | Codeine (LCMSMS) | ng/ml | | 16250-3 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z85 | Oxycodone (LCMSMS) | ng/ml | | 16249-5 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80102.Z86 | Hydrocodone (LCMSMS) | ng/ml | | 16252-9 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z34 | Diazepam (LCMSMS) | ng/mL | | 16227-1 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z35 | Nordiazepam (LCMSMS) | ng/mL | | 16228-9 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z37 | Alprazolam (LCMSMS) | ng/mL | | 59615-5 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z39 | Midazolam (LCMSMS) | ng/mL | | 16233-9 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z42 | Temazepam (LCMSMS) | ng/mL | | 20559-1 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z43 | Oxazepam (LCMSMS) | ng/mL | | 16201-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z44 | Lorazepam (LCMSMS) | ng/mL | | 17088-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z45 | Alpha-OH Alprazolam (LCMSMS) | ng/mL | | 16348-5 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z46 | Flurazepam (LCMSMS) | ng/mL | | 16231-3 | | r | 80100.Z201 | Drugs of Abuse 4001 | 80154.Z47 | Alpha-OH-Triazolam (LCMSMS) | ng/mL | | 49876-6 | | r | 80100.Z201 | Drugs of Abuse 4001 | 81000.Z15 | Toxicology Specific Gravity | | 3 | 5811-5 | | r | 80100.Z201 | Drugs of Abuse 4001 | 82542.Z25 | 7 amino-Clonazepam (LCMSMS) | ng/mL | | 51776-3 | | r | 80100.Z201 | Drugs of Abuse 4001 | 82570.Z15 | Tox Creatinine | mg/dL | 0 | 2161-8 | | r | 80100.Z201 | Drugs of Abuse 4001 | 83986.Z9 | Toxicology pH | | | 2756-5 |
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