Alverno Laboratories
Clinical Test Bulletins

Dear Healthcare Provider,

The information contained here may be very important to your practice. Please take a moment to review this document.


Cigna has issued a reimbursement Policy change, effective May 18, 2019. This change states that whoever performs the lab services must bill for the services. You will no longer be able to bill laboratory services under the Modifier 90 as you will not receive reimbursement for such test/test codes. If your office utilizes client billing, please contact your Account Executive to discuss the impact this may have on your office.


Please read pages 2 and 3 for the clinical use, background and changes that will be effective April 16, 2019.


Alverno Laboratories is pleased to announce that we will be switching instrument platforms for Heparin-Induced Thrombocytopenia (HIT) antibody testing. Please see additional information on page 4.

Thyroid Cascade – TSH w/Reflex

April 16, 2019

Clinical Use
Thyroid Stimulating Hormone (TSH) levels are used in part to assess thyroid function.

Clinical Background
Studies have shown that measurement of free T4 and total T3 along with a decreased TSH can help to determine the degree of hyperthyroidism. Alternatively, measurement of free T4 and thyroid peroxidase (TPO) antibody with an elevated TSH can help to determine the degree of hypothyroidism. All cutoff values listed in the diagram below are based on adults 18 years or older.

thyroid cascade algorithm

Specimen Requirements:
Specimen: 3.0mL serum/plasma
Stability: 7 days refrigerated
Cause for Rejection: Insufficient quantity, severely hemolyzed
Method: EIA
Reference Range: 0.270 – 4.200uIU/mL (adult)
Availability: Testing is available 24 hours a day, 7 days a week
CPT code: 84443*

Information regarding SOFT order codes and CPT codes* can be found on our website at or by calling 800-937-5521. *CPT codes provided are for informational purposes only. Questions regarding coding should be directed to the payer.

Heparin-Induced Thrombocytopenia Antibody Assay Update

April 9, 2019

Alverno Laboratories is pleased to announce that we will be switching instrument platforms for Heparin-Induced Thrombocytopenia (HIT) antibody testing. The new assay will reduce the number of false positive results and allow for a more rapid exclusion of a HIT diagnosis. Optimal patient testing includes the use of the 4T score (link included below) to increase pretest probability for HIT**. The new assay will be reported qualitatively with a positive or negative result and will include a reflex confirmatory functional Serotonin Release Assay (SRA). Please see ordering information below.

Specimen Requirements: Specimen: 2.0mL of Sodium Citrate plasma
Stability: Frozen up to 2 freeze/thaw cycles
Cause for Rejection: Clotted, insufficient quantity, severely hemolyzed
Method: Immunoturbidimetric
Reference Range: Negative
Availability: Batched three times daily
SOFT codes: HITRS – HIT AB. w/reflex to SRA

**4T score for probability of HIT – ASH Clinical Practice Guidelines. Diagnosis and Management of Heparin-Induced Thrombocytopenia (HIT)