M. tuberculosis complex, AFB Agar Proportion Drugs, Rifabutin

Laboratory Fee Schedule

Procedure: MAD0064A

CPT: 87190

M. tuberculosis complex, AFB Agar Proportion Drugs, Rifabutin
Synonym(s): M. tuberculosis complex drug susceptibility test (DST), RBT DST
Requisition Form G-MYCO
Test Description Susceptibility test to Rifabutin by agar proportion method
Pre-Approval Needed N/A
Supplemental Information Required N/A
Supplemental Form(s) N/A  
Performed on Specimens from (sources) Pure isolate from human sources
Sample/Specimen Type for Testing M. tuberculosis complex pure isolate in liquid or on solid culture medium
Minimum Volume/Size Required
  • Liquid culture - 2.0 mL
  • Solid culture - Visible growth, more than a single colony
Storage/Preservation Prior to Shipping Ambient
Transport Medium N/A
Specimen Labeling
  • At least 2 patient specific identifiers:  First and last name as one identifier and a DOB or a unique patient specific identifier (e.g. Medical records number).
  • Specimen identification must match specimen submission form.
Shipping and Specimen Handling Requirements
  • Ship according to Dangerous Goods Regulations, IATA, and/or CFR 49
  • Category A shipping applies
Method Agar proportion susceptibility test interpreted as either susceptible or resistant to a specific drug at critical concentration recommended by CLSI
Turn-around Time 14 to 21 days
  • Test can only be performed on pure cultures of M. tuberculosis complex
Causes for Rejection
  • Non-viable isolates
  • Cultures overgrown by contaminating organisms
  • Isolate not M. tuberculosis complex
Additional Information
  • Isolates submitted for this test will be identified by this laboratory.  No fee will be charged for this identification unless identification is requested on the G-MYCO requisition form.
  • This laboratory will notify submitter of new drug resistance detected by this test.

Last updated November 20, 2017