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94958: Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, CSF Print View
Tissue IFA Observation,CSF IFA     
ANNA1 (Hu) Ab, IFA, CSF IFA     
ANNA2 (RI) Ab, IFA, CSF IFA     
ANNA3 Ab, IFA, CSF IFA     
PCA1 (YO) Ab, IFA, CSF IFA     
PCA2 Ab, IFA, CSF IFA     
PCA TR (DNER) Ab, IFA,CSF IFA     
AGNA/SOX1 Ab, IFA, CSF IFA     
Amphiphysin Ab, IFA, CSF IFA     
CRMP5/CV2 AB, IFA, CSF IFA     
GAD65 Ab, IFA, CSF IFA     
MA2/TA Ab, IFA, CSF IFA     
Myelin Ab, IFA, CSF IFA     
Aquaporin 4 Ab, IFA, CSF IFA     
AQP4 Ab (IgG), Screen, CSF CBA IFA     
NMDAR1 Ab, CBA, CSF CBA IFA     
AMPAR1 Ab, CBA, CSF CBA IFA     
AMPAR2 Ab, CBA, CSF CBA IFA     
GABABR Ab, CBA, CSF CBA IFA     
LGI1 Ab, CBA, CSF CBA IFA     
CASPR2 Ab, CBA, CSF CBA IFA     
DPPX Rec Ab,CBA IFA,CSF CBA IFA     
VGKC Ab, CSF RIA    pmol/L 

PRIMARY
1 CSF 6 (3.5) mL   Room Temperature - 24 Hour(s)/Refrigerated - 7 Day(s)/Frozen - 14 Day(s)  
ALTERNATE

The Encephalitis Antibody Panel provides an evaluation of possible autoantibodies in patients with suspected autoimmune encephalitis, and optimizes the likelihood of detecting neuronal specific autoantibodies, whether present singly or occurring as multiple autoantibodies.
Setup Schedule
Tuesday-Saturday

Reported (Analytical Time)
14 days

CPT Codes
86255x20,86341,83519

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Notes
**This test is not available for New York patient testing**
Specimen Requirements: 6 mL (3.5 mL minimum) CSF collected in a sterile leak-proof container
Transport Temperature: Refrigerated
Reject Criteria: Received room temperature
Reflex Criteria:
1) A line blot consisting of 10 analytes will be performed at an additional charge (CPT code(s): 84182 x9, 86341) as a reflex for tissue mosaic IFA suggesting one or more of the analytes on the line
blot: ANNA1(Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CV2 (CRMP5), Amphiphysin, AGNA1 (SOX1), GAD65, DNER, and Zic4. If the tissue mosaic pattern suggests ANNA3, titer will be performed at an additional charge (CPT code(s): 86256). 2) If the tissue mosaic pattern suggests PCA-2, titer will be performed at an additional charge (CPT code(s): 86256). 3) If the tissue mosaic IFA suggests PCA-Tr (DNER) and Western Blot shows DNER negative and Yo negative, then cell based assay IFA for DNER will be performed at an additional charge (CPT code(s): 86255). a. If DNER CBA is positive, titer will be performed at an additional charge (CPT code(s): 86256). 4) If the tissue mosaic IFA suggests myelin antibody, then a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256). b. Myelin Associated Glycoprotein (MAG) Antibody Western Blot (CPT code(s): 84182), in turn reflexing to MAG-SGPG and MAG ELISA for quantitation, will be performed at an additional charge (CPT code(s): 83520 x2). 5) If the Mosaic CBA is positive for any given analyte (NMDAR1, AMPAR1, AMPAR2, GABA-B Receptor, LGI-1, CASPR2), and the individual CBAs DPPX and Aquaporin 4 antibody, then that analyte will be titered at an additional charge (CPT code(s): 86256 for each titer performed). 6) If DPPX is positive, titer will be performed at an additional charge (CPT code(s): 86256). 7) If the Aquaporin 4 (NMO, neuromyelitis optica) CBA is positive, the






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