Test Summary Sheet for:

Purpose
Identification and Quantitation
Method(s)
High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS)
Suggested CPT Code(s)
80347
New York State Approval Status

Approved

Turnaround Time

5 days

Test Includes
1 Diazepam Valium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
2 Nordiazepam High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
3 Oxazepam Serax® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
4 Temazepam Normison®; Restoril® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
5 Clobazam Frisium®; Urbanyl® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
6 Chlordiazepoxide Librium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
7 Lorazepam Ativan® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 10 Anxiolytic, Tranquilizer
8 7-Amino Clonazepam Clonazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Hypnotic, Sedative
9 Alprazolam Xanax® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
10 Alpha-Hydroxyalprazolam Alprazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 10 Anxiolytic, Sedative
11 1-Hydroxymidazolam Midazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
12 Hydroxytriazolam Triazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
13 Hydroxyethylflurazepam Flurazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
14 Desalkylflurazepam Flurazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
15 Estazolam ProSom® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative

Specimen Type
Urine
Requested Volume
1 mL
Minimum Volume
0.4 mL
Special Handling
None
Specimen Container
Plastic container (preservative-free)

Additional Collection Instructions

Transport Temperature
Refrigerated
Light Protection
Not Required
Rejection Criteria
Received Room Temperature. Received Frozen.

Rejection criteria pertain to clinical specimen submissions only.

Stability
Room Temperature: Not Stable
Refrigerated: 21 day(s)
Frozen (-20 °C): Not Stable
1 Diazepam Valium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
2 Nordiazepam High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
3 Oxazepam Serax® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
4 Temazepam Normison®; Restoril® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
5 Clobazam Frisium®; Urbanyl® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
6 Chlordiazepoxide Librium® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 20 Anxiolytic, Sedative
7 Lorazepam Ativan® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 10 Anxiolytic, Tranquilizer
8 7-Amino Clonazepam Clonazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Hypnotic, Sedative
9 Alprazolam Xanax® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
10 Alpha-Hydroxyalprazolam Alprazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 10 Anxiolytic, Sedative
11 1-Hydroxymidazolam Midazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
12 Hydroxytriazolam Triazolam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
13 Hydroxyethylflurazepam Flurazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
14 Desalkylflurazepam Flurazepam Metabolite High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative
15 Estazolam ProSom® High Performance Liquid Chromatography/ Tandem Mass Spectrometry (LC-MS/MS) ng/mL 5 Anxiolytic, Sedative

Interface Map

LOINC® Information

The CPT Codes provided in this document are based on AMA Guidelines and are for informational purposes only. NMS Labs Does not assume responsibility for billing errors due to Reliance on the CPT Codes listed in this document.

*The information contained in this document represents database configurations, as they will appear on the effective date listed above.