Test Requisition
HLA Typing - High Resolution
- HLA comprehensive high resolution typing
- HLA-A high resolution
- HLA-B high resolution
- HLA-C high resolution
- HLA-DRB1 high resolution
- HLA-DRB3/4/5 high resolution
- HLA-DQA1 high resolution
- HLA-DQB1 high resolution
- HLA-DPA1 high resolution
- HLA-DPB1 high resolution
HLA Typing - Intermediate Resolution
- HLA Class I typing - intermediate resolution
- HLA Class II typing - intermediate resolution
- HLA-A intermediate resolution
- HLA-B intermediate resolution
- HLA-C intermediate resolution
HLA Antibody Testing
- Class I PRA
- Class II PRA
- Class I single antigen
- Class II single antigen
- Class I single antigen - dilution
- Class II single antigen - dilution
Crossmatch
- T & B cell XM by flow cytometry
- T & B cell XM - Pronase treatment
- Endothelial cell crossmatch
- Virtual crossmatch
Chimerism Testing/STR
- Informatives (recipient & donor)
- Whole blood / bone marrow
- CD3 cell subset
- CD14/15 cell subset
- CD19 cell subset
- CD33 cell subset
- CD34 cell subset
- CD56 cell subset
- CD71 cell subset
- Granulocyte cell subset
KIR Genotyping
- KIR genotyping
Disease Association and Others
- HLA-A2 typing
- HLA-A68 typing
- HLA-B27 typing
- HLA-B51 typing
- HLA-B*15:02 typing
- HLA-B*57:01 typing
- HLA-B*58:01 typing
- HLA-DQ2 and DQ8 typing (Celiac)
Test Requistion Instructions
- Click the button below to open the form in your browser
- Save the form to your desktop and print it
- Mail it to us with your specimens
Interactive PDF Test Requisition
Sample Requirements
Please use the following guide when collecting sample for ITL:
Test Category |
Max. Number of Tubes for Patients >12 kg |
Sample Volume for Patients <12 kg |
---|---|---|
Antibody |
2 Red Top* |
3 mL in Red Top |
HLA Typing |
2 ACD* |
6 mL in small ACD |
Chimerism |
2 ACD* |
6 mL in small ACD |
Crossmatch Donor |
6 ACD* |
Please contact ITL |
Crossmatch Recipient |
1 Red Top* |
Please contact ITL |
Auto Crossmatch |
6 ACD* & 1 Red Top* |
Please contact ITL |
* Completely full 8.5 mL tubes
- If more than one test is ordered in the same category, collect no more than the maximum tube or sample volume indicated above.
- If two or more test categories are ordered, add the number of tubes together.
Important
Because of limited stability, samples should be collected Monday through Thursday avoiding holidays. Samples collected on a Friday, must be delivered to one of the three drop off locations (UCSF Clinical Lab, UCSF ACC Draw, and Mission Bay M2339) by 12:00 noon.
Fee Schedule
The ITL is approved by the Centers for Medicare and Medicaid Services (CMS) as a Free-standing Histocompatibility Laboratory (FSHL). This approval allows the ITL to perform testing for any transplant program in the United States, with uniform test charges for UCSF and non-UCSF clients. In addition, CMS determines the reimbursement rate for ITL tests and services based on its annual cost report and must charge institutions rather than individuals. The ITL testing fees are available to the public at the CMS website.
UCSF Immunogenetics & Transplantation Laboratory 2018
CMS #: 05-HL06
Download Fee Schedule (PDF)
Test Description | Price | CPT |
---|---|---|
HLA Class I (A,B,C) Typing (Intermediate Resolution) | 350 | 81372 |
HLA Class II (DR, DQ, DP) Typing (Intermediate Resolution) | 300 | 81375 |
HLA - A2 Typing | 165 | 81374 |
HLA - A68 Typing | 165 | 81374 |
HLA - B51 Typing | 175 | 81374 |
HLA - B27 Typing | 125 | 81374 |
HLA - A Typing (Intermediate Resolution) | 165 | 81373 |
HLA - B Typing (Intermediate Resolution) | 175 | 81373 |
HLA - C Typing (Intermediate Resolution) | 165 | 81373 |
HLA - A Typing (NGS - High Resolution) | 375 | 81380 |
HLA - B Typing (NGS - High Resolution) | 375 | 81380 |
HLA - C Typing (NGS - High Resolution) | 375 | 81380 |
HLA - DRB1 Typing (NGS - High Resolution) | 375 | 81382 |
HLA - DRB3/4/5 Typing (NGS - High Resolution) | 375 | 81382 |
HLA - DPB1 Typing (NGS - High Resolution) | 375 | 81382 |
HLA - DPA1 Typing (NGS - High Resolution) | 375 | 81382 |
HLA - DQB1 Typing (NGS - High Resolution) | 375 | 81382 |
HLA - DQA1 Typing (NGS - High Resolution) | 375 | 81382 |
HLA-A,B,C,DRB1,DRB3/4/5,DQA1,DQB1,DPA1,DPB1 Comprehensive Typing (NGS - High Resolution) |
1950 | 81378 |
HLA-B*5701 Typing | 375 | 81381 |
HLA-B*5801 Typing | 375 | 81381 |
HLA-B*1502 Typing | 375 | 81381 |
HLA Typing - Celiac | 300 | 81377 |
HLA Typing STAT Fee (Per Requisition Form) | 150 | |
KIR Genotype | 200 | 81403 |
KIR Genotyping STAT Fee (Per Requisition Form) | 150 | |
HLA Antibody PRA Class I | 200 | 86830 |
HLA Antibody PRA Class II | 200 | 86831 |
HLA Antibody ID - Single Antigen Class I | 350 | 86832 |
HLA Antibody ID - Single Antigen Class II | 350 | 86833 |
HLA Antibody ID - Single Antigen Class I (Dilution) | 350 | 86832 |
HLA Antibody ID - Single Antigen Class II (Dilution) | 350 | 86833 |
HLA Antibody Analysis with Single Antigen Titer, Class I | 900 | 86834 |
HLA Antibody Analysis with Single Antigen Titer, Class II | 900 | 86835 |
Antibody Testing STAT Fee (Per Set-up) | 400 | |
B-Cell & T-Cell Crossmatch by Flow Cytometry | 400 | 86825, 86826 |
B-Cell & T-Cell Flow Crossmatch With Pronase | 450 | 86825, 86826 |
Endothelial Cell Crossmatch | 250 | 86825, 86826 |
Crossmatch STAT Fee (Per Set-up) | 400 | |
Engraftment (Chimerism) Testing - Informative Loci | 250 | 81265 |
Engraftment (Chimerism) Testing by STR - Whole Blood/Bone Marrow | 375 | 81267 |
Engraftment (Chimerism) Testing by STR -(Cell Subsets) | 280 | 81268 |
Engraftment (Chimerism) Testing STAT Fee (Per Set-Up) | 150 | |
Deceased Donor Testing - Local | 2,100 | 86849 |
Deceased Donor Cell Preparation & Storage | 275 | 86849 |
Serum Management (Includes Kits, Postage, Processing & Storage) | 65 | 86849 |
Serum Storage | 25 | 86849 |
DNA Preparation & Storage | 25 | 86849 |
Turn-Around Time (TAT)
Turn-Around Time (TAT) | Expected (Day) | Current Median (Day) |
---|---|---|
HLA Antibody - PRA | <5 | 2 |
HLA Antibody - Single Antigen | <5 | 2 |
Crossmatch by Flow Cytometer | <3 | 1 |
HLA Typing - Intermediate Resolution | <5 | 3 |
HLA Typing - High Resolution (NGS) | <7 | 5 |
Chimerism Testing (STR) | <7 | 6 |
STAT Antibody Testing | <3 | 1 |
STAT Other Testing (e.g., chimerism) | <3 | 2 |
KIR Genotyping | <5 | 1 |