Congenital Hypomyelination Evaluation

Test Code
245

Test Details


Test code:245
Type of disorder:Peripheral Neuropathy, Hereditary
Disease(s) tested for:Congenital Hypomyelination Neuropathy
Genes Included: MPZ, EGR2,
Tests included:EGR2 DNA Sequencing Test
MPZ DNA Sequencing Test
Informed Consent Required:This test requires physician attestation that patient consent has been received

Technical Information


Clinical Significance:Detects sequence variants in the MPZ and EGR2 genes

Typical Presentation: Floppy infants with severe neuropathy and absence of peripheral nerve myelin
Methodology: Next Generation Sequencing
Reference Range:No sequence variants detected

CPT Coding


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.

CPT:81404(1), 81405(1)

Specimen Requirements


Please label each specimen tube with two forms of patient identification. These forms of identification must also appear on the requisition form.

Specimen Type:Whole blood
Specimen Stability: Room temperature: 10 days, Refrigerated: 10 days, Frozen: Unacceptable,
Specimen Requirements: 8 mL (6 mL minimum) whole blood collected in two (lavender-top) EDTA tubes. Pediatric (0-3 years): 2 mL (1 mL minimum)
Instructions:Higher blood volumes ensure adequate DNA quantity, which varies with WBC, specimen condition, and need for confirmatory testing. Patients, 0-3 years have higher WBC, yielding more DNA per mL of blood

Shipping Considerations


Transport Temperature:Room temperature
Set-up/Analytic Time:21-28 days

Additional Resources

Letters of Medical Necessity

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