Encephalitis Antibody Evaluation with Reflex, Serum

Encephalopathy-Autoimmune Evaluation, Autoimmune Encephalitis Panel

Test Codes

Order Reference Lab Miscellaneous Send Out: EPIC: LAB848, Beaker: Ref Lab Misc., Quest: 94955

Department

Send Outs

Specimen Collection Criteria

Collect: Two plain Red-top tubes.

Also acceptable: Two Gold-top SST tubes.

Physician Office/Draw Specimen Preparation

Let specimen clot 30-60 minutes then centrifuge to separate serum from cells. Transfer serum to a plastic transport tube and refrigerate (2-8°C or 36-46°F).

Preparation for Courier Transport

Transport: 8.0 mL serum, refrigerated (2-8°C or 36-46°F). (Minimum: 4.0 mL)

Rejection Criteria

• Grossly lipemic specimens.
• Grossly Icteric specimens.
• Grossly hemolyzed specimens.
• Received room temperature (>24 hours).
• Specimen Turbid.
• Bacterial contamination.
• Freeze/thaw greater than 3 cycles.
• Specimens not collected and processed as indicated.

In-Lab Processing

Let specimen clot 30-60 minutes then centrifuge to separate serum from cells. Transfer serum to a plastic transport tube and refrigerate (2-8°C or 36-46°F).

Transport: 8.0 mL serum, refrigerated (2-8°C or 36-46°F). (Minimum: 4.0 mL)

Storage

Specimen Stability for Testing:

Room Temperature (20-26°C or 68-78.8°F): Unacceptable
Refrigerated (2-8°C or 36-46°F): 14 days
Frozen (-20°C/-4°F or below): 28 days

Specimen Storage in Department Prior to Disposal:

Specimen retention time is determined by the policy of the reference laboratory. Contact the Send Outs Laboratory with any questions.

Laboratory

Sent to Quest Diagnostics, Wood Dale, IL.

Performed

Varies.
Results available in 3-12 days.

Reference Range

By report.

Test Methodology

Indirect Immunofluorescence Assay, Western Blot, Immunoblot, Radioimmunoassay, Cell-Binding Assay, Enzyme-Linked Immunosorbent Assay, Live-Cell Assay

Interpretation

Initial panel consists of: Encephalitis Ab Screen Tissue IFA, AMPAR1, AMPAR2, Aquaporin 4, DPPX, GABAbR, NMDAR1, CASPAR2, LGI1, Ganglionic AChR, VGCC N-Type, VGCC P/Q-Type, and VGKC.

1)A line blot consisting of 10 analytes will be performed at an additional charge (CPT codes(s): 84182 x9, 86341) as a reflex for tissue mosaic IFA suggesting one or more of the analytes on the line blot: ANNA1 (Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CV2 (CRMP5), Amphiphysin, AGNA1 (SOX1), GAD65, DNER, and Zic4. If the tissue mosaic pattern suggests ANNA3, then titer will be performed at an additional charge (CPT code(s): 86256).

2) If the tissue mosaic pattern suggests PCA-2, then titer will be performed at an additional charge (CPT code(s): 86256).

3) If the tissue mosaic IFA suggests PCA-Tr (DNER) and Western Blot shows DNER negative and Yo negative, then cell based assay IFA for DNER will be performed at an additional charge (CPT codes(s): 86255)
a. If DNER CBA is positive, then titer will be performed at an additional charge (CPT code(s): 86256).

4) If the tissue mosaic IFA suggests myelin antibody, then
a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256).
b. Myelin Associated Glycoprotein (MAG) Antibody, in turn reflexing to MAG-SGPG and MAG ELISA for quantitation, will be performed at an additional charge (CPT code(s): 83520 x2).

5) If the Mosaic CBA is positive for any given analyte (NMDAR1, AMPAR1, AMPAR2, GABA-B Receptor, LGI-1, CASPR2), and the individual CBAs DPPX and Aquaporin 4 antibody, then that analyte will be titered at an additional charge (CPT code(s): 86256 per titer, 86052 for AQP4 Titer).

6) If DPPX is positive, then titer will be performed at an additional charge (CPT code(s): 86256).

7) If the Aquaporin 4 (NMO, neuromyelitis optica) CBA is positive, then Aquaporin 4 CBA titer will be performed at an additional charge (CPT code(s): 86052

Clinical Utility

Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, Serum – The Encephalitis Antibody Panel provides an evaluation of possible autoantibodies in patients with suspected autoimmune encephalitis, and optimizes the likelihood of detecting neuronal specific autoantibodies, whether present singly or occurring as multiple autoantibodies.

CPT Codes

86255 x19, 86052 86341, 83519 x2, 83520 x2

Contacts

Last Updated

6/2/2026