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PAIN MANAGEMENT PANEL 4 RFLX

Test Code
PM4
 
This test may reflex to additional tests depending upon results of this test. No additional fee will be added if the reflex test is necessary.
Positive results will automatically relex to confirmation testing. Confirmation by GC/MS, LC-MS/MS, or GC/FID.
This test is a lab developed test. For further information, see the Compliance Remarks section below.
Important LinksPatient Prescription Record
SPECIMEN REQUIREMENTS
Container TypeRandom urine
Supply Item Numberpicture1387 or picture1678
Specimen TypeRandom urine
Preferred Volume30 mL
Emergency Minimum Volume15 mL
Collection ProcedureCollect a random urine in a leakproof plastic urine container.
Store and TransportAmbient (room temperature)
Required Patient InfoList last 5 days of prescription medicine taken by the patient
StabilityRoom Temp 10 days  Refrigerated 1 month  
Unacceptable ConditionBlood, serum, or plasma samples
CPT Codes80361, (HCPCS G0480), 80307, 80356, 80365
Interface Order Code80101.Z210
Billing CodePM42017
Test ScheduleMon-Sat
Turnaround Time1-3 days
MethodEnzyme Immunoassay, Confirmations by GC/MS, LC/MS/MS, or GC/FID
Reference Ranges
TitleDescriptorRangesUnits
Alcohol ScreenNegative< 20mg/dL
Alcohol by GC/FIDNot Detected< 8mg/dL
Amp/Methamphetamine ScreenNegative< 500ng/mL
Amphetamines by GC/MSNot Detected< 250ng/mL
Methamphetamine by GC/MSNot Detected< 250mg/mL
D-Methamphetamine by GC/MSNot Detected< 250%
L-Methamphetamine GC/MSNot Detected< 250%
Alternate Amphetamines ScreenNegative< 500ng/mL
MDMA by GC/MSNot Detected< 250ng/mL
MDA by GC/MSNot Detected< 250ng/mL
MDEA by GC/MSNot Detected< 250ng/mL
Cannabinoids Screen (20)Negative< 20ng/mL
Carboxy-THC by GC/MSNot Detected< 15ng/mL
Cocaine ScreenNegative< 150ng/mL
Benzoylecgonine by GC/MSNot Detected< 100ng/mL
Morphine by LC-MS/MS Not Detected< 50ng/mL
Oxymorphone by LC-MS/MSNot Detected< 50ng/mL
Hydromorphone by LC-MS/MSNot Detected< 50ng/mL
Nor-Oxycodone by LC-MS/MSNot Detected< 50ng/mL
Nor-Hydrocodone by LC-MS/MSNot Detected< 50ng/mL
Oxycodone by LC-MS/MSNot Detected< 50ng/mL
Codeine by LC-MS/MSNot Detected< 50ng/mL
Heroin Metab (6AM) by LC-MS/MSNot Detected< 10ng/mL
Hydrocodone by LC-MS/MSNot Detected< 50ng/mL
Phencyclidine ScreenNegative< 25ng/mL
Phencyclidine by GC/MSNot Detected< 6ng/mL
Propoxyphene ScreenNegative< 300ng/mL
Norpropoxyphene by GC/MSNot Detected< 80ng/mL
Barbiturates ScreenNegative< 200ng/mL
Amobarbital by GC/MSNot Detected< 50ng/mL
Butalbital by GC/MSNot Detected< 80ng/mL
Pentobarbital by GC/MSNot Detected< 50ng/mL
Phenobarbital by GC/MSNot Detected< 50ng/mL
Secobarbital by GC/MSNot Detected< 80ng/mL
Benzodiazepines ScreenNegative< 200ng/mL
Clonazepam by LC-MS/MSNot Detected< 10ng/mL
7-Aminoclonazepam by LC-MS/MSNot Detected< 10ng/mL
Flunitrazepam by LC-MS/MSNot Detected< 10ng/mL
7-Aminoflunitrazepam by LC-MS/MSNot Detected< 10ng/mL
Diazepam by LC-MS/MS Not Detected< 10ng/mL
Temazepam by LC-MS/MSNot Detected< 25ng/mL
Nordiazepam by LC-MS/MSNot Detected< 25ng/mL
Oxazepam by LC-MS/MSNot Detected< 25ng/mL
Lorazepam by LC-MS/MSNot Detected< 25ng/mL
Alprazolam by LC-MS/MSNot Detected< 10ng/mL
Alpha-hydroxyalprazolam by LC-MS/MSNot Detected< 25ng/mL
Flurazepam by LC-MS/MSNot Detected< 10ng/mL
Midazolam by LC-MS/MSNot Detected< 25ng/mL
Alpha-hydroxytriazolam by LC-MS/MSNot Detected< 25ng/mL
Methadone & Metabolite ScreenNegative< 100ng/mL
Methadone Metabolite (EDDP) by GC/MSNot Detected< 90ng/mL
Meperidine ScreenNegative< 200ng/mL
Meperidine by GC/MSNot Detected< 40ng/mL
Tramadol ScreenNegative< 200ng/mL
Tramadol by GC/MSNot Detected< 80ng/mL
Acetaminophen ScreenNegative< 2.5ug/mL
Fentanyl ScreenNegative< 2.0
Fentanyl by LC-MS/MSNot Detected< 2.0
Norfentanyl by LC-MS/MSNot Detected< 4.0
Carisoprodol ScreenNegative< 0.1ug/mL
Carisoprodol by GC/MSNot Detected< 2.5ug/mL
Meprobamate by GC/MSNot Detected< 2.5ug/mL
Buprenorphine ScreenNegative< 25ng/mL
Buprenorphine by GC/MSNot Detected< 5ng/mL
Nor-Buprenorphine by GC/MSNot Detected< 5ng/mL
ETG/ETS ScreenNegative< 250ng/mL
Ethyl Glucuroide by LC-MS/MSNot Detected< 250ng/mL
Ethyl Sulfate by LC-MS/MSNot Detected< 150ng/mL
OxidantsNormal< 200ug/mL
Urine pHNormal4.5-9.0
Urine CreatinineNormal> 19mg/dL
Specific GravityNormal1.003-1.020
GlucoseNegative< 20mg/dL
Compliance RemarksThis 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.
Reflex Testing
Reflex ConditionReflex Test NameReflex CPT codesReflex Billing codes
If any Analyte in panel positiveReflex testing built into panel, no additional test codes requiredReflex testing built into panel, no additional CPT codes requiredN/A
If screen for Alcohol is positive
If screen for Amphetamines is positive
If screen for Alternate Amphetamines is positive
If screen for Cannabinoids (THC) is positive
If screen for Cocaine is positive
If screen for Propoxyphene is positive
If screen for Phencyclidine is positive
If screen for Barbiturates is positive
If screen for Benzodiazepines is positive
If screen for Methadone is positive
If screen for Meperidine is positive
If screen for Tramadol is positive
If screen for Acetaminophen is positive
If screen for Fentanyl is positive
If screen for Carisoprodol/Meprobamate is positive
If screen for Buprenorphine is positive
If screen for ETG/ETS is positive

Interface Codes
typeorder codetest descriptionresult coderesult descriptionunitsdecimal placesloinc code
o80101.Z210Pain Management Panel 4
r80101.Z210Pain Management Panel 480101.Z193Clonazepamng/mL 16229-7
r80101.Z210Pain Management Panel 480101.Z198Alcohol Screenmg/dL 42242-8
r80101.Z210Pain Management Panel 480101.Z199Amp / Methamphetamine Screenng/mL 33280-9
r80101.Z210Pain Management Panel 480101.Z200Alternate Amphetamines Screenng/mL 19146-0
r80101.Z210Pain Management Panel 480101.Z201Cannabinoids Screenng/mL 42860-7
r80101.Z210Pain Management Panel 480101.Z202Cocaine Screenng/mL 3398-5
r80101.Z210Pain Management Panel 480101.Z203Phencyclidine Screenng/mL 3937-0
r80101.Z210Pain Management Panel 480101.Z204Propoxyphene Screenng/mL 19429-0
r80101.Z210Pain Management Panel 480101.Z205Barbiturates Screenng/mL 20664-9
r80101.Z210Pain Management Panel 480101.Z206Benzodiazepinesng/mL 9428-4
r80101.Z210Pain Management Panel 480101.Z207Methadone Screenng/mL 3774-7
r80101.Z210Pain Management Panel 480101.Z208Meperidine Screenng/mL 58385-6
r80101.Z210Pain Management Panel 480101.Z209Tramadol Screenng/mL 17719-6
r80101.Z210Pain Management Panel 480101.Z230Acetaminophen Screenug/mL159384-8
r80101.Z210Pain Management Panel 480101.Z2787-Aminoclonazepamng/mL 51776-3
r80101.Z210Pain Management Panel 480101.Z279Flunitrazepamng/mL 20528-6
r80101.Z210Pain Management Panel 480101.Z2807-Aminoflunitrazepamng/mL 51777-1
r80101.Z210Pain Management Panel 480101.Z281Diazepamng/mL 16227-1
r80101.Z210Pain Management Panel 480101.Z282Nordiazepamng/mL 16228-9
r80101.Z210Pain Management Panel 480101.Z283Alprazolamng/mL 59615-5
r80101.Z210Pain Management Panel 480101.Z284Flurazepamng/mL 16231-3
r80101.Z210Pain Management Panel 480101.Z285Midazolamng/mL 16233-9
r80101.Z210Pain Management Panel 480101.Z286Alpha-hydroxytriazolamng/mL 49876-6
r80101.Z210Pain Management Panel 480102.Z124Alcohol by GC/FIDmg/dL 46983-3
r80101.Z210Pain Management Panel 480102.Z125Amphetamine by GC/MSng/mL 20410-7
r80101.Z210Pain Management Panel 480102.Z126Methamphetamine by GC/MSng/mL 16235-4
r80101.Z210Pain Management Panel 480102.Z127MDMA by GC/MSng/mL 18358-2
r80101.Z210Pain Management Panel 480102.Z128MDA by GC/MSng/mL 20545-0
r80101.Z210Pain Management Panel 480102.Z129MDEA by GC/MSng/mL 45143-5
r80101.Z210Pain Management Panel 480102.Z130Carboxy-THC by GC/MSng/mL 20521-1
r80101.Z210Pain Management Panel 480102.Z131Benzoylecgonine by GC/MSng/mL 16226-3
r80101.Z210Pain Management Panel 480102.Z132Morphine by LC-MS/MSng/mL 16251-1
r80101.Z210Pain Management Panel 480102.Z133Oxymorphone by LC-MS/MSng/mL 17395-5
r80101.Z210Pain Management Panel 480102.Z134Hydromorphone by LC-MS/MSng/mL 16998-7
r80101.Z210Pain Management Panel 480102.Z135Nor-Oxycodone by LC-MS/MSng/mL 61425-5
r80101.Z210Pain Management Panel 480102.Z136Nor-Hydrocodone by LC-MS/MSng/mL 61422-2
r80101.Z210Pain Management Panel 480102.Z137Oxycodone by LC-MS/MSng/mL 16249-5
r80101.Z210Pain Management Panel 480102.Z138Codeine by LC-MS/MSng/mL 16250-3
r80101.Z210Pain Management Panel 480102.Z139Heroin Metab (6AM) by LC-MS/MSng/mL 19593-3
r80101.Z210Pain Management Panel 480102.Z140Hydrocodone by LC-MS/MSng/mL 16252-9
r80101.Z210Pain Management Panel 480102.Z141Phencyclidine by GC/MSng/mL 16254-5
r80101.Z210Pain Management Panel 480102.Z142Norpropoxyphene by GC/MSng/mL 17377-3
r80101.Z210Pain Management Panel 480102.Z143Amobarbital by GC/MSng/mL 16239-6
r80101.Z210Pain Management Panel 480102.Z144Butalbital by GC/MSng/mL 16237-0
r80101.Z210Pain Management Panel 480102.Z145Pentobarbital by GC/MSng/mL 16240-4
r80101.Z210Pain Management Panel 480102.Z146Phenobarbital by GC/MSng/mL 16241-2
r80101.Z210Pain Management Panel 480102.Z147Secobarbital by GC/MSng/mL 16238-8
r80101.Z210Pain Management Panel 480102.Z148Oxazepam by GC/MSng/mL 16201-6
r80101.Z210Pain Management Panel 480102.Z149Temazepam by GC/MSng/mL 20559-1
r80101.Z210Pain Management Panel 480102.Z150Lorazepam by GC/MSng/mL 17088-6
r80101.Z210Pain Management Panel 480102.Z151Alpha-OH Alprazolam by GC/MSng/mL 16348-5
r80101.Z210Pain Management Panel 480102.Z152Methadone Metab (EDDP) by GC/MSng/mL 58429-2
r80101.Z210Pain Management Panel 480102.Z153Meperidine by GC/MSng/mL 16253-7
r80101.Z210Pain Management Panel 480102.Z154Nor-Meperidine by GC/MSng/mL 58389-8
r80101.Z210Pain Management Panel 480299.Z60D-Methamphetamine%031026-8
r80101.Z210Pain Management Panel 480299.Z61L-Methamphetamine%015404-7
r80101.Z210Pain Management Panel 481000.Z18SpGravity 32965-2
r80101.Z210Pain Management Panel 481099.Z11Oxidantsug/mL 19146-0
r80101.Z210Pain Management Panel 482003.Z2Acetaminophen by GC/MSug/mL113622-6
r80101.Z210Pain Management Panel 482491.Z153Carisoprodol by GC/MSug/mL 58427-6
r80101.Z210Pain Management Panel 482491.Z154Carisoprodol Screenug/mL 10979-3
r80101.Z210Pain Management Panel 482541.Z12Tramadol by GC-MSng/mL 20561-7
r80101.Z210Pain Management Panel 482570.Z22Creatininemg/dL02161-8
r80101.Z210Pain Management Panel 483789.Z26Ethyl Glucu/Ethyl Sulfate Screenng/mL 19146-0
r80101.Z210Pain Management Panel 483789.Z27Ethyl Glucuronide by LC-MS/MSng/mL 58378-1
r80101.Z210Pain Management Panel 483789.Z28Ethyl Sulfate by LC-MS/MSng/mL 58425-0
r80101.Z210Pain Management Panel 483805.Z4Meprobamate by GC/MSug/mL 58374-0
r80101.Z210Pain Management Panel 483925.Z33Fentanyl Screenng/mL 58379-9
r80101.Z210Pain Management Panel 483925.Z34Fentanyl by LC-MS/MSng/mL 58381-5
r80101.Z210Pain Management Panel 483925.Z35Norfentanyl by LC-MS/MSng/mL 58383-1
r80101.Z210Pain Management Panel 483925.Z36Buprenorphine Screenng/mL 3415-7
r80101.Z210Pain Management Panel 483925.Z37Buprenorphine by GC/MSng/mL 49752-9
r80101.Z210Pain Management Panel 483925.Z38Norbuprenorphine by GC/MSng/mL 49751-1
r80101.Z210Pain Management Panel 483986.Z5pH  2756-5
r80101.Z210Pain Management Panel 499199.Z101Prescribed Drug 1  
r80101.Z210Pain Management Panel 499199.Z102Prescribed Drug 2  
r80101.Z210Pain Management Panel 499199.Z103Prescribed Drug 3  
r80101.Z210Pain Management Panel 499199.Z104Prescribed Drug 4  
r80101.Z210Pain Management Panel 499199.Z105Prescribed Drug 5  
r80101.Z210Pain Management Panel 499199.Z106Prescribed Drug 6  
r80101.Z210Pain Management Panel 499199.Z107Prescribed Drug 7  
r80101.Z210Pain Management Panel 499199.Z108Prescribed Drug 8  
r80101.Z210Pain Management Panel 499199.Z109Prescribed Drug 9  
r80101.Z210Pain Management Panel 499199.Z110Prescribed Drug 10  

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