Clinician Information Manual The Great Plains Laboratory, Inc. 11813 W. 77th St. Lenexa, Kansas 66214
[email protected] www.GreatPlainsLaboratory.com 913-341-8949 Toll-Free 800-288-0383
Your Representative ___________________________________ Account Representative ___________________________________ Direct Line ___________________________________ Mobile ___________________________________ E-mail
Revised: 7/13/2015
Clinician Information Manual Getting Started with Lab Testing
1
■ Introduction to The Great Plains Laboratory, Inc. ■ Test Kit Order Form ■ Additional Resources Available on Our Website ■ Brochures Available on Our Website ■ GPL3 and GPL4 Panels
Clinical Lab Test Recommendations
2
■ Top 5 Recommended Tests ■ Clinical Significance of the Organic Acids Test
Test & Pricing Information
3
■ Physician Test Price List ■ Patient Test Price List ■ Test Descriptions
Turn-Around Times and Specimen Collection
4
Insurance Billing, CPT & ICD-9 Codes
5
■ Insurance Overview ■ Insurance Coverage Verification Guide ■ CPT Codes for Insurance Billing (Individual Tests & Test Panels) ■ ICD-9 Codes for Insurance Billing
Sample Test Requisition Form
6
Nutritional Supplements
7
■ Distributor Price List ■ New Client Form
Introduction to Integrative Medicine for Mental Health (IMMH)
8
■ Introduction to IMMH & IMMH Website ■ Recommended Testing for Mental Health Patients ■ Introduction to Zeebra Formulations ■ Practitioner Supplement Recommendations
William Shaw, Ph.D., Director
11813 West 77th Street, Lenexa, KS 66214
(913) 341-8949
Fax (913) 341-6207
www.GPL4U.com
Getting Started With Lab Testing
Getting Started With Lab Testing
1
Getting Started with Lab Testing
Introduction to The Great Plains Laboratory, Inc. Welcome to The Great Plains Laboratory, Inc., where customer service is our number one priority. Our friendly staff is dedicated to helping both medical practitioners and patients to achieve their maximum potential through accurate and informative laboratory testing. As a client, you will appreciate the personal, one-on-one service that sets our laboratory apart from the rest. We hope you will take advantage of the new clinical tests we have to offer based on the latest research. Our laboratory staff works diligently with medical practitioners and individual patients to ensure that test results are thoroughly understood. Our knowledgeable customer service representatives are available by phone and by email to answer questions and to provide clear advice about how to order our tests. Our clients receive the maximum value for their test results, which includes a professional consultation. At The Great Plains Laboratory, Inc., we have coupled advanced technology with friendly assistance to offer the most complete, reliable, and understandable laboratory testing available. We look forward to working with you soon. Sincerely,
William Shaw, Ph.D. Laboratory Director
Website: www.GPL4U.com E-mail:
[email protected]
Getting Started with Lab Testing
Kit Order Form
Fax to: 913‐324‐5262
Clinic Name:
Physician Name:
Physician Phone:
Physician Title:
Physician Email:
Physician Fax:
Clinic Street Address: Clinic City, State & Zipcode: Quantity Test Kits
Quantity Test Kits
URINE KITS
BLOOD KITS
Amino Acids Urine Test ‐ Random Collection
Amino Acids Plasma Test (US only)
Amino Acids Urine Test ‐ 24 Hr Collection
Advanced Cholesterol Test IgE Food Allergy Basic Test IgE Inhalant Allergy Basic Test
Gluten / Casein Peptides Test GPL‐TOX Profile Metals Urine Test ‐ Random Collection Microbial Organic Acids Test (MOAT) Organic Acids Test (OAT) Phospholipase A2 Activity Test Uric Acid Test ‐ Random Collection
C‐Reactive Protein Test (hs‐CRP) Celiac Disease Test IgG Food Allergy Test w/ Candida IgG Asian Food Allergy Test w/ Candida IgE Food Allergy Essential (12) Test IgG Food Allergy Test + IgE Food Allergy Essential (12) Test Prealbumin Test Streptococcus Antibodies Profile Vitamin D Test ‐ Serum
Kryptopyrrole Test (US only)
IgE Allergy Advanced Combined Test
Metals Urine Test ‐ 24 Hr or Timed Collection Uric Acid Test ‐ 24 Hr Collection
IgE Food Allergy Advanced Test IgE Inhalant Allergy Advanced Test Ceruloplasmin Test Copper / Zinc Profile Comprehensive Fatty Acids Test (US & Canada only)
Porphyrins Test
STOOL KITS Metals Fecal Test
IgG Food Allergy Test w/ Candida ‐ Dried Blood Spot (DBS) IgG Asian Food Allergy Test w/ Candida (DBS) Immune Deficiency Profile
Yeast Culture w/ Sensitivity Test
Metals Red Blood Cell Test
Comprehensive Stool Analysis
COMBO KITS MOAT + Yeast Culture w/ Sensitivity Test Combo OAT + Amino Acids Urine Test Combo Random ___ 24 hr ___ OAT + IgG Food Allergy Test w/ Candida ‐ DBS Combo OAT + IgG Food Allergy Test w/ Candida ‐ Serum Combo
Metals Whole Blood Test Vitamin D Test ‐ Dried Blood Spot (DBS)
SALIVA KITS Hormones Comprehensive Panel Hormones Comprehensive Plus Panel Hormones Short Comprehensive Panel
OTHER MATERIALS
OAT + Yeast Culture w/ Sensitivity Test Combo
GPL Information Guides
GPL3: OAT + IgG Food Allergy Test ‐ DBS + Metals Hair
Pediatric Collection Bags
GPL4‐DBS: OAT + IgG Food Allergy Test w/ Candida HAIR KIT + Metals Hair + Phospholipase A2 Activity Test GPL4‐Serum: OAT + IgG Food Allergy Test w/ Candida Metals Hair Test + Red Blood Cell + Phospholipase A2 Activity Test
COMPREHENSIVE TEST PANELS Comprehensive Autism Panel Comprehensive AD(H)D Panel Comprehensive Tourette’s & Tics Panel Comprehensive Fibromyalgia & CFS Panel Comprehensive Wellness Panel Comprehensive Mental Health Panel
BASIC TEST PANELS Basic Autism Panel Basic AD(H)D Panel Basic Tourette’s & Tics Panel Basic Fibromyalgia & CFS Panel Basic Wellness Panel Basic Mental Health Panel
Additional Resources Available on Our Website Free Webinars The Great Plains Laboratory, Inc. uses the power of the internet to bring educational conferences into the comfort of your home. These webinars are educational seminars conducted by a wide range of experts on the topic of biomedical treatment and testing. The information is designed to provide useful information about the clinical manifestations that occur in certain disorders. The presenters draw from years of clinical experience to bring you important, helpful information about various situations that can occur in the body to create illness and disease. The presentations explain the topic in detail using language that is easy to understand. These live webinars are given frequently throughout the year. Specific dates can be found listed on the Upcoming Webinars section of our home page.
Sign Up to Receive Email Updates Emails will include information regarding new and updated tests, conferences, and webinars. A special publication called BioMed Today E-Newsletter is sent out quarterly in addition to the e-mails and includes a featured topic and related articles about new and updated discoveries in the biomedical field as well as upcoming events, discussions, tips, recent news, and other resources. Visit E-mail Sign Up under Upcoming Events on our website to sign up.
Books and DVDs We offer a variety of educational books and DVDs including Dr. Shaw’s books: “Biological Treatments for Autism and PDD” and “Autism: Beyond the Basics.” To place an order, go to GPL Bookstore under Resources on our website.
Integrative Medicine for Mental Health (IMMH) Clinician Registry & Resources Integrative medicine for mental health is a whole body approach utilizing multiple fields of medicine and nutritional sciences. The Integrative Medicine for Mental Health website contains a Registry where medical professionals are listed as resources to the community. Clinician Registry eligibility is exclusive to practitioners who have either attended an IMMH Conference or after viewing the IMMH Conference DVD. Visit www.IMMH.org for more information.
Educational Conferences The Great Plains Laboratory, Inc. regularly hosts, sponsors, and attends conferences around the world. These events provide patients and practitioners with the opportunity to learn more about the latest research and the clinical significance of tests and treatments. The conferences hosted by GPL provide an opportunity to learn about the complex metabolic pathways that are affected in particular disorders, and about environmental and genetic influences that are contributing to the symptoms of disease. To find out where GPL is participating in a conference, visit Upcoming Events on our website.
Clinician Educational Seminars The Great Plains Laboratory, Inc. frequently hosts clinician educational seminars designed to improve the scope of practice. We provide useful tools for practitioners to understand the various influences that complicate metabolic pathways and explain the connection in our test results. Using the latest research on specific compounds and metabolites, we bring new insight to the disease process. The practitioner will gain an understanding of the clinical significance of biomedical testing and a clear comprehension of the appropriate treatment. To find out when and where our next clinician educational seminar will be held, visit Upcoming Events on our website.
Sample Patient Health History Form This is a template available for you to use to obtain patient information and assess overall health.
Four Weeks to Dairy-Free This educational resource is to help those who are trying to embark on a casein-free (CF) or dairy-free diet. The guide contains information on how to get started, a list of foods that contain casein and their alternatives, recipes, meal ideas, and more. The daily instructions included in the guide can provide a smooth transition to a dairy-free lifestyle.
Patient Price List This resource is available for download. When placing kit orders, you can request sets of 12 for waiting room material.
Getting Started with Lab Testing
Brochures Available on Our Website Test Brochures William Shaw, Ph.D., Director
Upgraded Organic Acids Test Now With Additional Markers The Organic Acids Test The Organic Acids Test (OAT) provides a metabolic “snapshot” based on the products the body discards through the urine. These small, discarded organic acid molecules are byproducts of human cellular activity, the digestion of foods, and the metabolism of gastrointestinal flora. At certain levels, organic acids in urine may be indicators of toxicity or “markers” of the function of metabolic pathways. Levels of yeast or gastrointestinal bacteria metabolites are compared to normal levels of human metabolites, providing an assessment of yeast and bacterial activity. The Organic Acids Test includes 74 urinary metabolites (including creatinine) and two neurotransmitter ratios. Recently, two new markers of genetic disease were added to the panel, one of which has been linked to autism.
(913) 341-8949
Fax (913) 341-6207
www.GPL4U.com
Oxalate Control
Understanding IgE Reactions
levels of organic acids in their system. Factors which can cause or affect the intestinal yeast overgrowth include oral antibiotic use, excessive sugars in the diet, selective or combined immune deficiencies, genetic and other factors.
Patients and physicians have reported significant improvement upon treatment including: decreased fatigue, regular bowel movements, increased energy and alertness, increased concentration, improved verbal skills, less hyperactivity, better sleep patterns, and decreased abdominal pain.
Besides the new markers, the OAT still evaluates other important compounds including Krebs cycle metabolites and neurotransmitters. This reliable test detects the overgrowth of yeast and a bacteria species, Clostridia, commonly missed by conventional culture methods. These organisms and their metabolites can produce or magnify symptoms of many medical conditions. Identification of a yeast or bacterial overgrowth paired with a successful treatment can increase the probability of recovery.
AD(H)D
•
Alzheimer’s Disease
•
Anxiety Disorders
•
Asperger’s Syndrome
•
Autism Spectrum Disorders
•
Chronic Fatigue
•
Colitis and Crohn’s Disease
•
Depression
•
Down Syndrome
•
Endometriosis
•
Fibromyalgia
The Importance of IgE Testing Elimination of IgE-positive foods and reduction of exposure to inhalant allergens can bring about major improvements in many symptoms and disorders triggered by food and environmental sources. The Great Plains Laboratory, Inc. (GPL) offers both basic and advanced serum tests for specific IgE antibodies to a wide range of allergens. The advanced tests of 93 foods and 69 inhalants increase the probability that a patient may identify numerous allergy triggers. In the IgE Inhalant Allergy Advanced Test, we have included Candida and Thimerosal markers.
•
Learning Disabilities
•
Movement Disorders
•
Multiple Sclerosis
•
Obsessive Compulsive Disorder Recurrent Infections
•
Tic Disorders Tourette Syndrome
(continued on page 2)
Although IgE allergies are associated with “immediate” and therefore easily discernible reactions, not all IgE responses are so clear. Testing is an important adjunct to the patient’s symptom reporting in identifying triggers.
•
•
http://patienteducation.upmc.com/Pdf/ LowOxalateDiet.pdf
Test results show which foods and inhalants are associated with elevated IgE antibodies that may cause reactions. These results help guide health practitioners in customizing therapies for their patients.
Gastrointestinal Disorders, Diarrhea or Constipation
“I believe the Great Plains IgG Food Allergy Test is a phenomenal tool that I
A free phone consultation with our nutritional consultant is available to practitioners and patients with physician approval.
practice on a daily basis to help treat patients for a wide variety of symptoms like headaches,
Better receptive and expressive
IBS, fatigue, abdominal
language
pain, dermatitis, hair loss,
Increased imitation skills
joint pain, acne, thyroid
Increased sociability
disorders, and vitamin
Decreased rigidity
deficiencies. I believe I am
Better sleep
a better physician due to
Reduced self-abusive behavior
this testing transforming
Increased imaginary play
Oxalates in the urine are much higher in individuals with autism than in normal children (Figure 1). As a matter of fact, 36% of the children on the autism spectrum had values higher than 90 mmol/mol creatinine, the value consistent with a diagnosis of genetic hyperoxalurias while none of the normal children had values this high. 84% of the
Easy to Understand Results
have implemented in my
Benefits reported by parents using low oxalate diet according to Susan Owens Improved gross and fine motor skills Better counting ability
36% of the children on the autism spectrum had values higher than 90 mmol/ mol creatinine, the value consistent with a diagnosis of a genetic hyperoxaluria.
my ability to properly
Improved cognition Decreased bed wetting
diagnose and treat patients
Less frequent urination
effectively.”
Improved handwriting
– Bridget, M.D.
Less fatigue and more energy And many others
Organic Acids Test - Oxalates
Organic Acids Test
For more information or to request a test kit, contact us Phone: (913) 341-8949 Fax: (913) 341-6207 Toll Free: 1-800-288-0383 www.greatplainslaboratory.com E-mail:
[email protected]
OAT Oxalates Brochure 06/05/13
IgE Food & Inhalant Allergy Tests
Page 1
Organic Acids Test Brochure 8/22/12
Oxalates and Autism A brand new diet is being extensively used to treat children with autism and other disorders. Oxalate and its chemically similar form oxalic acid are widely used in industry. A researcher named Susan Owens discovered that the use of a diet low in oxalates markedly reduced symptoms in children with autism and PDD. For example, the mother of an autistic son reported that he became more focused and calm, that he played better, that he walked better, and had a reduction in leg and feet pain after being on a low oxalate diet. Prior to the low oxalate diet, her child could hardly walk up the stairs. After the diet, he walked up the stairs very easily. Many hundreds of children with autism throughout the world are now being placed on this diet with good results.
06/18/14
gE Food & nha ant A ery Tests
Organ c Ac ds Test OAT
Page 1
11813 West 77th Street, Lenexa, KS 66214
(913) 341-8949
Fax (913) 341-6207
(913) 341-8949
Fax (913) 341-6207
www.GPL4U.com
Human IgG is separated into four subclasses denoted IgG1, IgG2, IgG3, and IgG4.9 Each subclass varies in abundance and biological function. IgG1 and IgG3 are predominantly responsible for antibody protection against reinfection. IgG2 antibodies are opsonic (marking a pathogen for ingestion and destruction) and develop in response to carbohydrate polysaccharide antigens. IgG4 molecules function as skin-sensitizing immunoglobulins and are thought to block antibodies produced in response to chronic exposure to antigens.
Antigen Binding Sites
Fab Region
Fc Region
Immunoglobulin Figure 1 Structure
Clinical Usefulness
(913) 341-8949
Our two test options, plasma and urine amino acids analyze 40 amino acids and provide a detailed explanation of the causes and possible consequences of detected abnormalities, along with nutritional recommendations. By using The Great Plains Laboratory, Inc. you will receive the benefits of testing and free consultations with experts, ongoing free e-mail and phone support, high quality control, detailed explanation of results, and easy testing procedures.
Most people receive substantial vitamin D through sunlight exposure. Vitamin D can also come from supplementation and diet; however, there are very few foods that naturally contain vitamin D. Some foods that contain vitamin D are fatty fish, fish liver oil, and eggs. The Vitamin D Test at The Great Plains Laboratory, Inc. can help to determine if sun exposure is adequate, if dietary vitamin D is sufficient, and can assess the likelihood of malabsorption or liver disease.
Vitamin D Deficiency By Population The NHANES provided data on the vitamin D nutritional status of the US population. Approximately 9% of the pediatric population, representing 7.6 million US children and adolescents, were vitamin D deficient, and 61%, representing 50.8 million US children and adolescents, did not have optimal levels of vitamin D. Generally, younger people had higher vitamin D levels than older people, males had higher levels than females, and non-Hispanic whites had higher levels than Mexican Americans, who in turn had higher levels than non-Hispanic blacks. Depending on the population group, 1-9% had levels 800
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125- 370 12- 30 12- 90 12- 40 8.0- 16 100- 190 0.20- 0.55 0.26- 0.50 0.030- 0.10 0.050- 0.13 0.60- 4.0 0.25- 1.3 0.007- 0.023 160- 250 0.95- 1.7 0.16- 1.0 45500- 53000 0.16- 0.80 0.013- 0.035 8.0- 19 0.045- 0.065 0.016- 0.18 0.040- 1.0
facebook.com/GPL4U | twitter.com/greatplainslab www.linkedin.com/company/the-great-plains-laboratory-inc.
About us
The Great Plains Laboratory, Inc. (GPL) is a research-based clinical laboratory offering testing for nutritional factors in chronic illnesses worldwide. We are dedicated to assisting healthcare practitioners make a difference by helping children, adults, and families achieve their maximum potential through quality laboratory testing. We are always happy to hear from our clients and welcome your questions, comments, or suggestions. We’re available to provide consultations for physicians, and help find a medical practitioner in your area. 4- 30 email:
[email protected] web: www.GPL4U.com phone: (913) 341-8949 0.88 V06.99
0.5- 10 4- 20 > 800
We are providers for Blue Cross Blue Shield®, Cigna®, Tricare®, and United Healthcare®. www.GPL4U.com
Top 5 Recommended Tests 01/08/14
Blue Cross Blue Shield, Cigna, Tricare, and UnitedHealthcare logos are Registered Trademarks of their respective companies. Use of these names and logos represents the Great Plains Laboratory, Inc.’s coverage status with these insurance carriers. The Great Plains Laboratory Inc. is not affiliated with or sponsored by Blue Cross Blue Shield®, Cigna®, Tricare®, or UnitedHealthcare®.
4
The Clinical Significance of the Organic Acids Test The Organic Acids Test (OAT) provides an accurate metabolic snapshot of what is going on in the body. Besides offering the most complete and accurate evaluation of intestinal yeast and bacteria, it also provides information on important neurotransmitters, nutritional markers, glutathione status, oxalate metabolism, and much more. The test includes 74 urinary metabolite markers that can be very useful for discovering underlying causes of chronic illness. Patients and physicians report that treating yeast and bacterial abnormalities reduces fatigue, increases alertness and energy, improves sleep, normalizes bowel function, and reduces hyperactivity and abdominal pain.
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Don’t miss our upcoming events, including one-day Organic Acids Testing workshops! Visit www.GreatPlainsLaboratory.com for event dates and locations. Tryptophan Meta 36
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Clinical Significance of the Organic Acids Test 04/09/15
Page 1
1.2
- Nutritional and
Metabolic Profi le
Page 2 of 8
William Shaw, Ph.D., Director
11813 West 77th Street, Lenexa, KS 66214
(913) 341-8949
Fax (913) 341-6207
www.GPL4U.com
The following pages list the 74 metabolite markers of the Organic Acids Test. Included is the name of the metabolic marker, its clinical significance, and usual initial treatment. INTESTINAL MICROBIAL OVERGROWTH Yeast and Fungal Markers Citramalic Acid
Elevated citramalic acid is produced mainly by Saccharomyces species or Propionibacteria overgrowth. High-potency, multi-strain probiotics may help rebalance GI flora.
5-Hydroxy-methyl-furoic Acid
A metabolite produced by Aspergillus and possibly other fungal species in the GI tract. Prescription or natural antifungals, along with high-potency, multi-strain probiotics, may reduce overgrowth levels.
3-Oxoglutaric Acid
Indicates a possible yeast overgrowth in the GI tract. High-potency, multi-strain probiotics may help rebalance GI flora.
Furan-2,5-dicarboxylic Acid
A metabolite produced by Aspergillus and possibly other fungal species in the GI tract. Prescription or natural antifungals, along with high-potency, multi-strain probiotics, may reduce overgrowth levels.
Furancarbonylglycine
A metabolite produced by Aspergillus and possibly other fungal species in the GI tract. Prescription or natural antifungals, along with high-potency, multi-strain probiotics, may reduce overgrowth.
Tartaric Acid
Produced by action of Candida hyaluronidase on the intercellular cement, hyaluronic acid. Oxidation of the hyaluronic acid breakdown by white blood cell hypochlorite produces tartaric acid and arabinose. Antifungal treatment and high-potency, multi-strain probiotics may help rebalance GI flora.
Arabinose
Produced by action of Candida hyaluronidase on the intercellular cement, hyaluronic acid. Oxidation of the hyaluronic acid breakdown by white blood cell hypochlorite produces tartaric acid and arabinose. Antifungal treatment and high-potency, multi-strain probiotics may help rebalance GI flora.
Carboxycitric Acid
Elevated yeast/fungal metabolites indicate overgrowth in the GI tract. Prescription or natural antifungals, along with high-potency, multi-strain probiotics, may reduce overgrowth.
Tricarballylic Acid
A chemical byproduct released from fumonisins during passage through the gastrointestinal tract. Fumonisins are fungal toxins produced primarily by F. verticillioides. Elevated levels can be caused by the intake of corn or corn-based food contaminated with fumonisins.
Bacterial Markers Hippuric Acid
A bacterial product of phenylalanine metabolism. Most hippuric acid in urine is derived from microbial breakdown of chlorogenic acid, a common substance found in beverages and in many fruits and vegetables. Higher levels indicate GI bacterial overgrowth that can be reduced with natural antibacterial agents and/or high-potency, multi-strain probiotics.
2-Hydroxyphenylacetic Acid
Elevated 2-hydroxyphenylacetic acid is associated with intestinal bacteria overgrowth. High-potency, multi-strain probiotics may help rebalance GI flora.
4-Hydroxybenzoic Acid
A marker for intestinal dysbiosis. Results may also show elevated values as a result of ingestion of foods such as jams and pie fillings containing paraben preservatives. The use of probiotics and the exclusion of paraben-containing foods is the first treatment consideration.
4-Hydroxyhippuric Acid
A glycine conjugate of 4-hydroxybenzoic acid, a metabolite of paraben preservatives. May be elevated after exposure to paraben antimicrobials in certain foods and cosmetics. Intake of fruits containing polyphenols rich in anthocyanins, flavonols, and hydroxycinnamates may increase this compound in the urine. Avoid exposure to parabens.
DHPPA in urine indicates intake of chlorogenic acid, a common substance in beverages and many fruits and vegetables. Harmless or beneficial bacteria such as Lactobacilli, Bifidobacteria, and E. coli increase DHPPA (dihydroxyphenylpropionic acid) the breakdown of chlorogenic acid to DHPPA, so high values are mainly associated with increased amounts of these species in the GI tract.
1
Clostridia Bacterial Markers 4-Hydroxyphenylacetic Acid
A tyrosine metabolic product of GI bacteria. Elevated levels are associated with bacterial overgrowth or small bowel disease. May also indicate celiac disease.
HPHPA (3-(3-hydroxyphenyl)-3hydroxypropionic acid)
An elevated value indicates an overgrowth of certain Clostridia bacteria in the GI tract including C. sporogenes, C. caloritolerans, and C. botulinum. This metabolite is commonly elevated in autism, psychiatric disorders, and GI disorders. This metabolite inhibits the enzyme dopamine-betahydroxylase, leading to a derangement of neurotransmitter balance.
4-Cresol
An elevated value indicates an overgrowth in the GI tract of C. difficile. This metabolite is commonly elevated in autism, psychiatric disorders, and GI disorders. This metabolite inhibits the enzyme, dopamine-beta-hydroxylase, leading to a derangement of neurotransmitter balance.
3-Indoleacetic Acid
3-Indoleacetic acid is a tryptophan byproduct of the following Clostridia species: C. stricklandii, C. lituseburense, C. subterminale, and C. putrefaciens. Very high amounts of this metabolite derived from tryptophan may indicate a depletion of tryptophan needed for other physiological functions.
OXALATE METABOLITES Glyceric Acid
Elevated in genetic hyperoxaluria type II. Normal values of glyceric acid rule out genetic causes of significant elevation of oxalic acid in urine.
Glycolic Acid
Very elevated in genetic hyperoxaluria type I. Normal values of glycolic acid rule out genetic causes of significant elevation of oxalic acid in urine. This genetic disease can be confirmed by DNA testing at the Mayo Clinic.
Oxalic Acid
Elevated oxalic acid may be associated with dysbiosis from Aspergillus, Penicillium, and possibly Candida, or from high doses of vitamin C. If yeast or fungal markers are elevated, antifungal therapy may reduce oxalates. Elevated oxalic acid may also result from anti-freeze (ethylene glycol) poisoning.
GLYCOLYTIC CYCLE METABOLITES
Lactic Acid
Elevated by a number of nonspecific influences, such as vigorous exercise, bacterial overgrowth of the GI tract, shock, poor perfusion, B-vitamin deficiency, mitochondrial dysfunction or damage, and anemia, among others. Tiglylglycine is a more specific indicator of mitochondrial dysfunction or damage. The possibility of an inborn error of metabolism increases when the lactic acid value exceeds 300 mmol/ mol creatinine. There are many inborn errors of metabolism that are present with elevated lactic acid, including disorders of sugar metabolism, pyruvate dehydrogenase deficiency, and mitochondrial disorders.
Pyruvic Acid
Elevated by a number of non-specific factors, including vigorous exercise, bacterial overgrowth of the GI tract, shock, poor perfusion, B-vitamin deficiency, mitochondrial dysfunction or damage, and anemia, among others. High pyruvic acid indicates the possibility of an inborn error of metabolism when the value exceeds 100 mmol/mol creatinine.
Clinical Significance of the Organic Acids Test 04/09/15
2
William Shaw, Ph.D., Director
11813 West 77th Street, Lenexa, KS 66214
(913) 341-8949
Fax (913) 341-6207
www.GPL4U.com
MITOCHONDRIAL MARKERS - KREBS CYCLE METABOLITES Succinic Acid
An elevated result may indicate a relative deficiency of riboflavin and/or coenzyme Q10. Also produced by bacterial degradation of unabsorbed glutamine supplement. Low levels may indicate the need for leucine/isoleucine supplementation. Suggest supplementation with riboflavin and/or coenzyme Q10.
Fumaric Acid
Increased urinary fumaric acid may be due to impaired Krebs cycle function, a defect in the enzyme fumarase, or in mitochondrial function. To support mitochondrial function, supplement with coenzyme Q10, nicotinamide adenine dinucleotide (NAD+), L-carnitine and acetyl-L-carnitine, riboflavin, nicotinamide, biotin, and vitamin E.
Malic Acid
Slightly elevated values usually indicate a higher need for nutrients such as niacin and coenzyme Q10. When malic acid is simultaneously elevated with citric, fumaric, and 2-ketoglutaric acids, a mitochondrial energy pathway dysfunction is strongly suggested.
2-Oxoglutaric Acid
Increased values in urine may be due to dietary vitamin deficiencies or the intake of 2-ketoglutaric acid as a supplement. The conversion of 2-oxoglutaric acid to succinyl-CoA requires coenzyme A (derived from pantothenic acid), flavin adenine dinucleotide (FAD) derived from riboflavin, and thiamine.
Aconitic Acid
Aconitase, the enzyme that metabolizes citric and aconitic acids, is dependent upon glutathione. Elevated in mitochondrial disorders (e.g. Complex I and Pierson Syndrome). Elevated aconitic acid may indicate an additional requirement for reduced glutathione.
Citric Acid
Elevations may be due to increased intake of citric acid-containing foods or result from intestinal yeast-producing citric acid, or perhaps inhibiting the human citric acid cycle. Increased citric acid may also indicate depletion of glutathione, which is required for the enzyme, aconitase to metabolize both aconitic and citric acids. If pyroglutamic acid values are low, consider supplements containing glutathione, or n-acetyl-cysteine.
MITOCHONDRIAL MARKERS - AMINO ACID METABOLITES 3-Methylglutaric Acid 3-Methylglutaconic
Significant increase is due to a reduced ability to metabolize the amino acid, leucine. This abnormality is found in the genetic disease, methylglutaconic aciduria and in mitochondrial disorders. 3-Methylglutaconic acid may also be elevated. Supplementation with coenzyme Q10, niacin, L-carnitine and acetyl-L-carnitine, riboflavin, nicotinamide, biotin, and vitamin E may be useful.
3-Hydroxyglutaric
Marker of glutaryl CoA dehydrogenase deficiency. This enzyme is involved in the breakdown of lysine, hydroxylysine, and tryptophan, and is associated with the genetic disease, glutaric aciduria type 1. Elevated 3-hydroxyglutaric acid may occur in combination with glutaric and glutaconic acids. Symptoms of glutaryl CoA dehydrogenase deficiency are varied. Some individuals appear normal, while others display encephalopathy, autism, cerebral palsy, and additional neurological abnormalities. Treatment includes adherence to a diet low in lysine and supplementation with carnitine.
NEUROTRANSMITTER METABOLISM Phenylalanine and Tyrosine Metabolites HVA and VMA
HVA (homovanillic acid), a dopamine metabolite, and VMA (vanillylmandelic acid), a metabolite of epinephrine and norepinephrine, are often elevated due to stress increasing catecholamine output from the adrenal gland, or from lead toxicity. Elevated HVA may also result from the intake of L DOPA, dopamine, phenylalanine, or tyrosine, or due to Clostridia metabolites.
HVA/VMA Ratio
An elevated ratio is often the result of a decreased conversion of dopamine to norepinephrine by the enzyme, dopamine beta-hydroxylase. Inhibition of this enzyme is commonly caused by Clostridia byproducts, including HPHPA, 4-cresol, and 4-hydroxyphenylacetic acid. Continued on the next page
3
Tryptophan Metabolites
5-Hydroxyindoleacetic Acid
Metabolite of the neurotransmitter, serotonin. Elevated values may result from supplementing tryptophan or 5 hydroxy tryptophan (5-HTP). Low values may indicate inadequate production of the neurotransmitter, serotonin. Often slightly elevated by ingestion of foods high in serotonin, such as avocado, banana, tomato, plum, walnut, pineapple, or eggplant. High values are found in carcinoid syndrome.
Quinolinic Acid
Increased values in urine may be caused by various factors such as chronic inflammation from microbial infections, central nervous system degeneration, excessive tryptophan supplementation, or even exposure to phthalates. Reduce excess quinolinic acid by eliminating tryptophan supplementation and also reduce exposure to infections and environmental pollutants. Brain damage induced by quinolinic acid can be mitigated by supplements containing acetyl L-carnitine, melatonin, B6, turmeric, and garlic.
Kynurenic Acid (KYNA)
The most common causes of elevated kynurenic acid are the use of tryptophan supplements and the presence of chronic infections. Very high urine values are found in genetic disorders involving kynureninase deficiency.
Quinolinic Acid / 5-HIAA Ratio
A high ratio indicates excessive inflammation due to recurrent infections, excessive tryptophan intake, immune overstimulation, excessive adrenal production of cortisol, or excessive exposure to phthalates.
PYRIMIDINE METABOLITES - FOLATE METABOLISM Uracil
Because folic acid is involved as a methyl donor in the conversion of uracil to thymine, elevated uracil may indicate a defect in folic acid metabolism. Elevated uracil is found in about 10% of children with autism.
Thymine
Slightly elevated urinary thymine has no clinical significance. High values are associated with inflammatory diseases and cancer. Elevated pyrimidines and elevated thymine have been reported in dihydropyrimidine dehydrogenase deficiency, a rare genetic disease, which has been associated with seizures and autism.
KETONE AND FATTY ACID OXIDATION 3-Hydroxybutyric Acid Acetoacetic Acid
Ketones, such as 3-hydroxybutyric and acetoacetic acids, are the end-products of rapid or excessive fatty acid breakdown. Common causes of elevated ketones are prolonged fasting, protein malnutrition, high fat diet, vitamin B12 deficiency, severe GI Candida overgrowth, and pulmonary infections.
4-Hydroxybutyric Acid
A moderate urinary increase in 4-hydroxybutyric acid may be due to intake of dietary supplements containing 4-hydroxybutyric acid, also known as gamma-hydroxybutyric acid. Very high levels may indicate the genetic disorder involving succinic semialdehyde dehydrogenase deficiency.
Adipic Acid
Slightly elevated adipic acid may result from excessive ingestion of gelatin or other “junk” food containing adipic acid as an additive. Elevated adipic acid may also indicate an abnormality in fatty acid metabolism. Dietary supplements containing L-carnitine or L-acetyl-carnitine may be beneficial.
Suberic Acid Sebacic Acid Ethylmalonic Acid Methylsuccinic Acid
Increased urinary products of the omega fatty acid metabolism pathway may be due to carnitine deficiency, fasting, or increased intake of triglycerides from coconut oil, or some infant formulas. Very elevated values may indicate a genetic disorder. Fatty acid oxidation defects are associated with hypoglycemia and lethargy. Regardless of cause, intake of dietary supplements containing L-carnitine or acetyl-L-carnitine may improve clinical symptoms.
Clinical Significance of the Organic Acids Test 04/09/15
4
William Shaw, Ph.D., Director
11813 West 77th Street, Lenexa, KS 66214
(913) 341-8949
Fax (913) 341-6207
www.GPL4U.com
NUTRITIONAL MARKERS Methylmalonic Acid (Vitamin B12)
Slightly elevated methylmalonic acid is commonly associated with vitamin B12 deficiency, or other factors such as pernicious anemia, GI bacterial metabolism, malabsorption, or gastroenteritis in very young infants. Very elevated values may indicate a genetic disorder.
Pyridoxic Acid (Vitamin B6)
A major metabolite of vitamin B6. High pyridoxic acid indicates high recent intake of vitamin B6. Because some individuals may require very high doses of vitamin B6, high values do not necessarily indicate the need to reduce vitamin B6 intake. Low values are associated with low B6 status, high oxalates, and/or low neurotransmitters.
Pantothenic Acid (Vitamin B5)
An essential vitamin (vitamin B5). High pantothenic acid indicates high recent intake of pantothenic acid. Since some individuals may require very high doses of pantothenic acid, high values do not necessarily indicate the need to reduce pantothenic acid intake.
Glutaric Acid (Vitamin B2)
Elevation indicates riboflavin deficiency (vitamin B2), a common factor in moderate urinary increases of glutaric acid. Other possible factors include fatty acid oxidation defects and metabolic effects of valproic acid (Depakene), or celiac disease. The probability of a genetic disease is higher with very high values. The use of dietary supplements containing riboflavin and coenzyme Q10 may improve clinical symptoms. This compound may be elevated in about 10% of children with autism.
Ascorbic Acid (Vitamin C)
Commonly elevated by supplementation. High values are usually of no concern, except in individuals with extremely high intake (>2000 mg/day), in whom ascorbic acid may be converted to oxalic acid, increasing the risk of kidney stones. It is unlikely that elevated vitamin C will contribute to kidney stone formation if oxalic acid is in the normal range.
The precursor of coenzyme Q10 and cholesterol. Slightly increased values may be caused by 3-Hydroxy-3-methylglutaric Acid gastrointestinal yeast overgrowth. A moderate increase in urine HMG may also indicate decreased (Coenzyme Q10) synthesis of coenzyme Q10. Certain cholesterol-lowering drugs may inhibit the synthesis pathway and result in high HMG values. Very elevated values may be caused by the genetic disorder, HMG aciduria. N-Acetylcysteine Acid
A powerful antioxidant that increases the glutathione reserves in the body. Together with glutathione, acetylcysteine directly binds to toxic metabolites. Although acetylcysteine may be beneficial under certain conditions, excessive use of the supplement could be harmful.
Methylcitric Acid (Biotin (Vitamin H)
Elevation usually indicates a biotin deficiency (Vitamin H). Biotin deficiency may be due to malabsorption, excessive intake of raw egg white, dietary deficiency, or dysbiosis. Higher levels may indicate the presence of genetic disorders involving biotin-dependent enzymes and may require biotin supplementation at very high doses.
INDICATORS OF DETOXIFICATION Glutathione
Pyroglutamic Acid
Pyroglutamic acid is a metabolite of glutathione. Glutathione serves as an antioxidant and is also conjugated to toxic compounds in the liver. Elevated values are most commonly caused by glutathione deficiency due to toxic exposure, such as acetaminophen toxicity. Elevated pyroglutamic acid may also result from a genetic disorder, metabolic effects of certain antibiotics, or intake of certain infant formulas. Supplementation with liposomal glutathione or N-acetyl-cysteine can raise glutathione levels. Selenium is essential to the antioxidant activity of glutathione; usually, adequate selenium can be obtained from a quality multivitamin.
2-Hydroxybutyric Acid
Elevated 2-hydroxybutyric acid is a byproduct of the breakdown of the sulfur amino acid metabolite, cystathionine, which may be formed in excess during oxidative stress or when toxic exposures increase the need for detoxification. When glutathione is depleted by excessive toxic exposure, pyroglutamic acid may also be elevated. High values of 2-hydroxybutyric acid may also be associated with the onset of diabetes mellitus or significant alcohol intake. This compound may also be elevated in certain genetic diseases such as lactic acidosis, glutaric aciduria type II, dihydrolipoyl dehydrogenase (E3) deficiency, and propionic aciduria. Continued on the next page
5
Ammonia Excess Orotic Acid
Elevations are most commonly associated with ammonia toxicity. Elevated ammonia may result from drug toxicity to the liver, viral liver infection, gastrointestinal bleeding, or inborn errors of ammonia metabolism. Confirmation of a genetic disorder requires testing plasma amino acids.
Aspartame, Salicylates, or GI bacteria 2-Hydroxyhippuric Acid
A conjugate of the amino acids, glycine and hydroxybenzoic acid (salicylic acid). Intake of aspirin (salicylates) or the growth of salicylate-producing gastrointestinal bacteria may elevate levels. Also increased after the ingestion of the artificial sweetener, aspartame (Nutrasweet).
AMINO ACID METABOLITES 2-Hydroxyisovaleric Acid 2-Oxoisovaleric Acid 3-Methyl-2-oxovaleric Acid 2-Hydroxyisocaproic Acid 2-Oxoisocaproic Acid
A moderate increase of branched-chain amino acid metabolites in urine may result from lactic acidosis, episodic ketosis, or deficiencies of the vitamins, thiamine or lipoic acid. Elevated 2-hydroxyisocaproic acid in urine has also been linked to short bowel syndrome. A significant increase of branched-chain amino acid metabolites is associated with the genetic disorders, maple syrup urine disease (MSUD) and pyruvate dehydrogenase deficiency. Patients with slight to moderate elevations may use dietary supplements containing thiamine to improve clinical symptoms.
2-Oxo-4-methiolbutyric Acid
Elevated in an inborn error of methionine metabolism. Confirmation of the genetic disorder requires testing of plasma amino acids.
Mandelic Acid
Increased by dietary phenylalanine or phenylalanine supplementation, but also due to exposure to styrene, a toxic environmental compound. Significant elevation is found in the genetic disorder, phenylketonuria (PKU). A plasma phenylalanine test will rule out PKU.
Phenyllactic Acid
A metabolite of phenylalanine. Elevated values indicate increased intake of dietary phenylalanine or the heterozygous carrier status (homozygosity) for the genetic disease, phenylketonuria (PKU). Values observed in clinically diagnosed PKU typically exceed 200 mmol/mol creatinine.
Phenylpyruvic Acid
Moderate elevations may result from intake of phenylalanine, from genetic carrier status for PKU, or from a deficiency in production of biopterin, a cofactor required for phenylalanine metabolism. Very high values are associated with the genetic disease, PKU.
Homogentisic Acid
Homogentisic acid is elevated in the genetic disorder, homogentisic aciduria (alkaptonuria). Slight increases may indicate the heterozygous genetic carrier state of the disease.
4-Hydroxyphenyllactic Acid
Increased values are commonly associated with tyrosinemias, which can result from immature development of enzyme synthesis in infants or genetic deficiencies. Slight increases may be due to increased tyrosine intake, bacterial gut metabolism, short bowel syndrome, or liver disease.
N-Acetylaspartic Acid
Elevated N-acetylaspartic acid is due to the genetic disorder, Carnavan’s disease, a potentially fatal disease causing spongy degeneration of the brain.
Malonic Acid
Associated with the genetic disorders, malonyl-CoA decarboxylase deficiency and malonic aciduria with normal malonyl-CoA decarboxylase activity. Slightly elevated values in urine are unlikely to be clinically significant.
MINERAL METABOLITES
Phosphoric Acid
Phosphate urinary excretion is directly proportional to dietary intake. Processed foods high in phosphate include: sodas, candy, ice cream, chocolate, mayonnaise, frozen pizza, commercially baked goods, and meats. Excess phosphate is also associated with hyperparathyroidism, vitamin D-resistant rickets, immobilization following paraplegia or fracture due to bone resorption, vitamin D intoxication, blood lead levels above 1.5 ppm, renal tubular damage, familial hypophosphatemia, and metabolic acidosis. Low urinary phosphate is most common in low phosphate intake and in vitamin D deficiency.
Clinical Significance of the Organic Acids Test 04/09/15
6
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Test & Pricing Information
Test & Pricing Information
3
Test & Pricing Information
Physician Price List Nutritional, Environmental, and Metabolic Assessments Organic Acids Test (OAT) (74) – Urine Microbial Organic Acids Test (MOAT) (21) – Urine
Physician Billing Price*
Patient Cash Price**
List Price***
Out-of-Network Down Payment****
$239 $159
$299 $199
$599 $449
$120 $90
$135
$27
Advanced Cholesterol Profile – Serum
$85
$110
Amino Acids Test - Plasma or Urine (24 hr. or Random) (43)
$199
$229
Insurance Not Available
C-Reactive Protein Test (hs-CRP) – Serum
$55
$70
$85
Ceruloplasmin Test – Serum
$60
$85
$95
$19
Comprehensive Fatty Acids Test – Serum
$209
$239
$299
$60
(when ordered with the OAT/MOAT)
$199 ($149)
$219 ($169)
Insurance Not Available
$129
$129
Insurance Not Available
(when ordered with the OAT/MOAT)
$99 ($39)
$99 ($39)
$55
$70
$85
$17
$65 ($29)
$65 ($29)
$85 ($39)
$17 ($8)
$48
$58
$99
$20
Physician Billing Price*
Patient Cash Price**
List Price***
Out-of-Network Down Payment****
GPL-TOX (Toxic Organic Chemical Profile) Kryptopyrrole Test – Urine Phospholipase A2 Activity Test (PLA2) Prealbumin Test – Serum Uric Acid Test (24 hr. or Random) – Urine
(when ordered with the OAT/MOAT)
Vitamin D Test – Serum or Dried Blood Spot (DBS) DNA Methylation Pathway DNA Methylation Pathway Profile – Dried Blood Spot (DBS) Stool Tests Comprehensive Stool Analysis with Parasitology Yeast Culture w/ Sensitivity Test Hormone Tests Hormones Comprehensive Panel Hormones Comprehensive Plus Panel Hormones Short Comprehensive Panel
$17
Insurance Not Available
$429
$459
Physician Billing Price*
Patient Cash Price**
Insurance Not Available List Price***
Out-of-Network Down Payment****
$295 $140
$345 $170
$599 $225
$92 $45
Physician Billing Price*
Patient Cash Price**
List Price***
Out-of-Network Down Payment****
$215 $225
$225 $275
$255 $325
$51 $65
$195
$215
$225
$45
Physician Billing Price*
Patient Cash Price**
List Price***
Out-of-Network Down Payment****
IgG Food Allergy Test w/ Candida (94) – Serum or Dried Blood Spot (DBS) IgG Asian Food Allergy Test w/ Candida (94) – Serum or Dried Blood Spot (DBS)
$165 $165
$219 $219
$325 $325
$65 $65
Celiac Disease Test – Serum
$85
$109
$165
$33
Gluten / Casein Peptides Test – Urine
$85
$110
$119
$24
IgE Allergy Advanced Combined Test (93 / 69) – Serum
$700
$729
$800
$160
Food Allergies, Sensitivities, and Immune System
IgE Food Allergy Essentials Test (12) – Serum
$75
$75
$119
$24
IgE Food Allergy Basic Test (25) – Serum IgE Food Allergy Advanced Test (93) – Serum
$219 $449
$270 $479
$379 $579
$76 $116
IgE Inhalant Allergy Basic Test (36) – Serum IgE Inhalant Allergy Advanced Test (69) – Serum
$219 $349
$270 $379
$379 $449
$76 $90
Immune Deficiency Profile – Serum Streptococcus Antibodies Profile – Serum
$179 $55
$239 $70
$299 $85
$60 $17
Physician Billing Price*
Patient Cash Price**
List Price***
Out-of-Network Down Payment****
Metals Hair Test (39) Copper Test – Serum
$115 $35
$140 $35
$250 $60
$50 $12
Copper / Zinc Profile – Serum
$135
$165
$215
$43
Metals Fecal Test (13)
$115
$140
$250
$50
Metals Red Blood Cell Test (18)
$235
$285
$360
$72
Metals Urine (24 hr., Timed or Random) Test (37)
$165
$185
$299
$60
Metals Whole Blood Test (20)
$180
$210
$320
$64
Porphyrins Profile – Urine
$85
$109
$145
$29
Zinc Test – Serum
$35
$35
$60
$12
Metals and Essential Elements
Physician Billing Price*
Patient Cash Price**
List Price***
Out-of-Network Down Payment****
OAT + Amino Acids Urine Test Combo – Urine OAT + IgG Food Allergy Test w/ Candida Combo – Urine & Serum or Dried Blood Spot (DBS) OAT + Yeast Culture w/ Sensitivity Test Combo – Urine & Stool
$425
$515
$899
$180
$399
$499
$699
$140
$319
$399
$699
$140
MOAT + Yeast Culture w/ Sensitivity Test Combo – Urine & Stool
$239
$299
$549
$110
GPL3: Organic Acids Test + Metals Hair + IgG Dried Blood Spot (DBS)
$514
$559
$949
$190
$562
$599
$1048
$210
$682
$699
$1,158
$232
$279
$444
$89
Combo Tests
GPL4-DBS: Organic Acids Test + IgG Food Allergy Test + Metals Hair + Phospholipase A2 Activity Test GPL4-Serum: Organic Acids Test + IgG Food Allergy Test + Red Blood Cell + Phospholipase A2 Activity Test IgG Food Allergy Test w/ Candida + IgE Food Allergy Essentials Test – Serum
Test Panels
$225 Physician Billing Price*
Patient Cash Price**
List Price***
Out-of-Network Down Payment****
$1,495
$1,835
$2,599
$492
$894
$1,094
$1,667
$305
$1,716
$2,070
$3,124
$597
$808
$988
$1,367
$273
$1,686
$2,070
$3,124
$597
$753
$918
$1,268
$254
$1,188
$1,457
$2,376
$447
$599
$749
$1,068
$214
$1,366
$1,655
$2,440
$488
$723
$878
$1,248
$250
$1,570
$1,895
$2,714
$515
$1,007
$1,217
$1,666
$333
Comprehensive Autism Panel Advanced Cholesterol Profile Comprehensive Stool Analysis Copper / Zinc Profile Ferritin Test
Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida Immune Deficiency Profile Metals Hair Test
Organic Acids Test Streptococcus Antibodies Profile Vitamin D Test
IgG Food Allergy Test w/ Candida Metals Hair Test
Organic Acids Test
Basic Autism Panel Comprehensive Stool Analysis Gluten / Casein Peptides Test
Comprehensive AD(H)D Panel Advanced Cholesterol Profile Amino Acids Urine Test Comprehensive Fatty Acids Test Comprehensive Stool Analysis
Copper / Zinc Profile Ferritin Test Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test Streptococcus Antibodies Profile Vitamin D Test
IgG Food Allergy Test w/ Candida Metals Hair Test
Organic Acids Test
Basic AD(H)D Panel Comprehensive Fatty Acids Test Gluten / Casein Peptides Test
Comprehensive Tourette’s & Tics Panel Advanced Cholesterol Profile Amino Acids Urine Test Comprehensive Stool Analysis Copper / Zinc Profile
Ferritin Test Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida Immune Deficiency Profile
Metals Hair Test Organic Acids Test Streptococcus Antibodies Profile Vitamin D Test
Basic Tourette’s & Tics Panel Advanced Cholesterol Profile Ferritin Test
IgG Food Allergy Test w/ Candida Metals Hair Test
Organic Acids Test Streptococcus Antibodies Profile
Comprehensive Fibromyalgia & CFS Panel Amino Acids Urine Test C-Reactive Protein Test Comprehensive Stool Analysis
Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida Metals Hair Test
Organic Acids Test Vitamin D Test
Basic Fibromyalgia & CFS Panel Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test
Comprehensive Wellness Panel Advanced Cholesterol Profile Amino Acids Urine Test Comprehensive Fatty Acids Test Copper / Zinc Profile
Ferritin Test Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida Metals Hair Test
Organic Acids Test Vitamin D Test
Basic Wellness Panel Comprehensive Fatty Acids Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test
Comprehensive Mental Health Panel Advanced Cholesterol Profile Amino Acids Plasma Test Comprehensive Fatty Acids Test Comprehensive Stool Analysis
Copper / Zinc Profile Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida Metals Hair Test
Organic Acids Test Vitamin D Test
Basic Mental Health Panel Amino Acids Plasma Test Comprehensive Fatty Acids Test
Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test
* Physician billing is unavailable in New Jersey and Rhode Island. ** Payment must be submitted with sample. We accept checks, money orders, wire transfers, and all major credit cards. *** Price commonly billed to insurance. See insurance section on website or Test Requisition Form for exceptions. **** Out-of-network down payment (approx. 20% of list price) due upon submission (no up-front payment for in-network billing: some BCBS, Tricare, and Medicare). All prices are subject to change without prior notice.
Revised 07/10/15
Patient Price List Nutritional, Environmental, and Metabolic Assessments Organic Acids Test (OAT) (74) – Urine
Cash Price*
List Price**
Out-of-Network Down Payment***
$299
$599
$120
Microbial Organic Acids Test (MOAT) (21) – Urine
$199
$449
$90
Advanced Cholesterol Profile – Serum
$110
$135
$27
Amino Acids Test – Plasma or Urine (24 hr. or Random) (43)
$229
C-Reactive Protein Test (hs-CRP) – Serum
$70
Insurance Not Available
$85
$17
Ceruloplasmin Test – Serum
$85
$95
$19
Comprehensive Fatty Acids Test – Serum
$239
$299
$60
GPL-TOX (Toxic Organic Chemical Profile)
(when ordered with the OAT/MOAT)
$219 ($169)
Insurance Not Available
$129
Insurance Not Available
(when ordered with the OAT/MOAT)
$99 ($39)
Prealbumin Test – Serum Uric Acid Test (24 hr. or Random) – Urine (when ordered with the OAT/MOAT) Vitamin D Test – Serum or Dried Blood Spot (DBS)
$70 $65 ($29) $58
$85 $85 ($39) $99
$17 $17 ($8) $20
DNA Methylation Pathway
Cash Price*
List Price**
Out-of-Network Down Payment***
Kryptopyrrole Test – Urine Phospholipase A2 Activity Test (PLA2)
DNA Methylation Pathway Profile – Dried Blood Spot (DBS)
$459
Insurance Not Available
Insurance Not Available
Cash Price*
List Price**
Out-of-Network Down Payment***
Comprehensive Stool Analysis with Parasitology
$345
$599
$92
Yeast Culture w/ Sensitivity Test
$170
$225
$45
Cash Price*
List Price**
Out-of-Network Down Payment***
$225
$255
$51
Stool Tests
Hormones Tests Hormones Comprehensive Panel Hormones Comprehensive Plus Panel
$275
$325
$65
Hormones Short Comprehensive Panel
$215
$225
$45
Cash Price*
List Price**
Out-of-Network Down Payment***
IgG Food Allergy Test w/ Candida (94) – Serum or Dried Blood Spot (DBS)
$219
$325
$65
IgG Asian Food Allergy Test w/ Candida (94) – Serum or Dried Blood Spot (DBS)
$219
$325
$65
Celiac Disease Test – Serum
$109
$165
$33
Gluten / Casein Peptides Test – Urine
$110
$119
$24
IgE Allergy Advanced Combined Test (93 / 69) – Serum
$729
$800
$160
IgE Food Allergy Essentials Test (12) – Serum
$75
$119
$24
Food Allergies, Sensitivities, and Immune System
IgE Food Allergy Basic Test (25) – Serum
$270
$379
$76
IgE Food Allergy Advanced Test (93) – Serum
$479
$579
$116
IgE Inhalant Allergy Basic Test (36) – Serum
$270
$379
$76
IgE Inhalant Allergy Advanced Test (69) – Serum
$379
$449
$90
Immune Deficiency Profile – Serum
$239
$299
$60
Streptococcus Antibodies Profile – Serum
$70
$85
$17
Cash Price*
List Price**
Out-of-Network Down Payment***
Metals Hair Test (39)
$140
$250
$50
Copper Test – Serum
$35
$60
$12
Copper / Zinc Profile – Serum
$165
$215
$43
Metals Fecal Test (13)
$140
$250
$50
Metals Red Blood Cell Test (18)
$285
$360
$72
Metals Urine (24 hr., Timed or Random) Test (37)
$185
$299
$60
Metals Whole Blood Test (20)
$210
$320
$64
Porphyrins Profile – Urine
$109
$145
$29
Zinc Test – Serum
$35
$60
$12
Metals and Essential Elements
Cash Price*
List Price**
Out-of-Network Down Payment***
OAT + Amino Acids Urine Test Combo – Urine
$515
$899
$180
OAT + IgG Food Allergy Test w/ Candida Combo - Urine & Serum or Dried Blood Spot (DBS)
$499
$699
$140
OAT + Yeast Culture w/ Sensitivity Test Combo – Urine & Stool
$399
$699
$140
MOAT + Yeast Culture w/ Sensitivity Test Combo – Urine & Stool
$299
$549
$110
GPL3: Organic Acids Test + Metals Hair + IgG Dried Blood Spot (DBS)
$559
$949
$190
GPL4-DBS: Organic Acids Test + IgG Food Allergy Test + Metals Hair + Phospholipase A2 Activity Test
$599
$1048
$210
GPL4-Serum: Organic Acids Test + IgG Food Allergy Test + Red Blood Cell + Phospholipase A2 Activity Test
$699
$1,158
$232
IgG Food Allergy Test w/ Candida + IgE Food Allergy Essentials Test – Serum
$279
$444
$89
Cash Price*
List Price**
Out-of-Network Down Payment***
Combo Tests
Test Panels Comprehensive Autism Panel: Advanced Cholesterol Profile Comprehensive Stool Analysis Copper / Zinc Profile Ferritin Test
Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida Immune Deficiency Profile Metals Hair Test
Organic Acids Test Streptococcus Antibodies Profile Vitamin D Test
$1,835
$2,599
$492
Metals Hair Test IgG Food Allergy Test w/ Candida
Organic Acids Test
$1,094
$1,667
$305
$2,070
$3,124
$597
$988
$1,367
$273
$2,070
$3,124
$597
$918
$1,268
$254
$1,457
$2,376
$447
$749
$1,068
$214
$1,655
$2,440
$488
$878
$1,248
$250
$1,895
$2,714
$515
$1,217
$1,666
$333
Basic Autism Panel Comprehensive Stool Analysis Gluten / Casein Peptides Test
Comprehensive AD(H)D Panel Advanced Cholesterol Profile Amino Acids Urine Test Comprehensive Fatty Acids Test Comprehensive Stool Analysis
Copper / Zinc Profile Ferritin Test Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test Streptococcus Antibodies Profile Vitamin D Test
Metals Hair Test Organic Acids Test
IgG Food Allergy Test w/ Candida
Basic AD(H)D Panel Comprehensive Fatty Acids Test Gluten / Casein Peptides Test
Comprehensive Tourette’s & Tics Panel Advanced Cholesterol Profile Amino Acids Urine Test Comprehensive Stool Analysis Copper / Zinc Profile
Ferritin Test Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida Immune Deficiency Profile
Organic Acids Test Streptococcus Antibodies Profile Vitamin D Test Metals Hair Test
Basic Tourette’s & Tics Panel Advanced Cholesterol Profile Ferritin Test
Metals Hair Test Organic Acids Test
IgG Food Allergy Test w/ Candida Streptococcus Antibodies Profile
Comprehensive Fibromyalgia & CFS Panel Amino Acids Urine Test C-Reactive Protein Test Comprehensive Stool Analysis
IgG Food Allergy Test w/ Candida Metals Hair Test Organic Acids Test
Gluten / Casein Peptides Test Vitamin D Test
Basic Fibromyalgia & CFS Panel Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test
Comprehensive Wellness Panel Advanced Cholesterol Profile Amino Acids Urine Test Comprehensive Fatty Acids Test Copper / Zinc Profile
Ferritin Test Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test Vitamin D Test
Basic Wellness Panel Comprehensive Fatty Acids Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test
Comprehensive Mental Health Panel Advanced Cholesterol Profile Amino Acids Plasma Test Comprehensive Fatty Acids Test Comprehensive Stool Analysis
Copper / Zinc Profile Gluten / Casein Peptides Test IgG Food Allergy Test w/ Candida
Metals Hair Test Organic Acids Test Vitamin D Test
Basic Mental Health Panel Amino Acids Plasma Test Comprehensive Fatty Acids Test
IgG Food Allergy Test w/ Candida Metals Hair Test
Gluten / Casein Peptides Test Organic Acids Test
All prices are subject to change without prior notice. * Payment must be submitted with sample. We accept checks, money orders, wire transfers, and all major credit cards. ** Price commonly billed to insurance. Some BCBS plans are not considered in-network, see insurance section on website or Test Requisition Form for exceptions. *** Out-of-network down payment (approx. 20% of list price) due upon submission (no up-front payment for in-network billing: some BCBS, Tricare, and Medicare).
Revised 07/10/15
Test / Turn Around Time Advanced Cholesterol Profile 2 - 4 weeks
Amino Acids Urine Test (43) Amino Acids Plasma Test (43) 2 - 4 weeks
C-Reactive Protein Test (hs-CRP) 1 - 3 weeks
Description Total cholesterol, Apolipoprotein A-1 (Apo A-1), Apolipoprotein B (Apo B), Lipoprotein (a) (Lp (a)), Homocysteine Alanine, Beta-Alanine, Alpha-Aminoadipic, Alpha-Aminobutyric, Gamma-Aminobutyric, Beta-Aminoisobutyric, Ammonia, Anserine, Arginine, Asparagine, Aspartic, Carnosine, Citrulline, Cystathionine, Cysteine, Cystine, Ethanolamine, Glycine, Glutamic, Glutamine, Histidine, Homocysteine, Hydroxyproline, Isoleucine, Leucine, Lysine, Met Sulfoxide, Methionine, 1-Methylhistidine, 3-Methylhistidine, Ornithine, Phenylalanine, Phosphoethanolamine, Phosphoserine, Proline, Sarcosine, Serine, Taurine, Threonine, Tryptophan, Tyrosine, Valine, Urine Only – Creatinine and Urea High Sensitivity C-Reactive Protein
Celiac Disease Test (2 - 4 weeks)
Transglutaminase Antibody, Confirmatory test for Celiac Disease
Ceruloplasmin Test (1 - 3 weeks)
Ceruloplasmin
Comprehensive Fatty Acids Test
Total Saturated, Total Monounsaturated, Total Polyunsaturated, Total Omega 3, Total Omega 6, Total Fatty Acids. Omega 3 Series: Alpha-Linolenic, Eicosapentaenoic, Docosapentaenoic, Docosahexaenoic. Omega 6 Series: Linoleic, Gamma-Linolenic, Dihomo-Gamma-Linolenic, Arachidonic, Docosapentaenoic, Docosatetraenoic. Omega 9 Series: Eicosatrienoic. Monosaturated Series: Lauroleic, Myristoleic, Palmitoleic, Hexadecenoic, Vaccenic, Oleic, Nervonic. Saturated: Caprylic, Lauric, Myristic, Palmitic, Stearic, Arachidic, Docosanoic, Tetracosanoic, Hexacosanoic. Branched-chain: Pristanic, Phytanic. Ratios: Triene-to-Tetraene. Bacterial culture: 73 potential species of imbalanced and dysbiotic bacteria, 4 species of beneficial bacteria. Yeast (Mycology) culture: 48 potential yeast and fungal species. Parasite isolation: 22 potential parasites. Digestion and Absorption markers: Elastase, Fat Stain, Muscle Fibers, Vegetable fibers, and Carbohydrates. Inflammation markers: Lysozyme, Lactoferrin, White Blood Cells, Mucus. Immunology: Secretory Immunoglobulin A (sIgA). Short Chain Fatty Acids: Acetate, Propionate, Butyrate, Valerate. Intestinal Health markers: Red Blood Cells, pH, Occult Blood, Yeast (microscopy). Yeast sensitivity to: Fluconazole, Itraconazole, Nystatin, Flucytosin, Berberine, Caprylic acid, Uva Ursi, Goldenseal, Tanalbit, Oregano. Bacterial sensitivity to: Augmentin, Cefpodoxime, Cefuroxime, Ciprofloxacin, Tetracycline, Trimeth-sulfa, Berberine, Black Walnut, Caprilic Acid, Cats Claw, Goldenseal, Mastica, Oregano, Uva Ursi
1 - 3 weeks
Comprehensive Stool Analysis 2 - 4 weeks
Copper Test (1 - 3 weeks)
Copper
Copper / Zinc Profile (1 - 3 weeks)
Bound Copper, Unbound Copper, Total Copper, Zinc, Ceruloplasmin
DNA Methylation Pathway Profile
ACAT / 1-02, AHCY 1/2/19, BHMT 1, 3, 4, 8, CBS C699T/ A360A/ N212N, COMT V158M, H62H, 61, MAO A/ R297R, MTHFR C677T/A1298C/3, MTR/ A2756G, MTRR, A66G/H595Y/K350A/R415T/S257T/11, NOS / D298E, SHMT/ C1420T, SUOX/ S370S, VDR Taq1/ Fok1
5 – 6 weeks
Gluten / Casein Peptides Test 1 - 2 weeks
Gliadorphin (peptide from wheat) and Casomorphin (peptide from dairy products)
GPL3 (2 - 3 weeks)
See Organic Acids Test (OAT) (74), Metals Hair Test (39) and IgG Food Allergy Test w/ Candida (94)
GPL4-DBS (2 - 3 weeks)
See Organic Acids Test (OAT) (74), IgG Food Allergy Test w/ Candida (94), Metals Hair Test (39) and Phospholipase A2 Activity
GPL4-Serum (2 - 3 weeks)
See Organic Acids Test (OAT) (74), IgG Food Allergy Test w/ Candida (94), Metals Red Blood Cell Test (18) and Phospholipase A2 Activity
GPL-TOX (11) (1 – 2 weeks)
2-,3-,4-Methylhippuric Acid (2MHA, 3MHA,4MHA), 2,4-Dichlorophenoxyacetic Acid (2,4D), 2-Hydroxyisobutyric Acid (2HIB), 3-Phenoxybenzoic Acid (3PBA), Diethylphosphate (DEP), Dimethylphosphate (DMP), Monoethyl Phthalate (MEP), N-acetyl phenyl cysteine (NAP), Phenylglyoxylic Acid (PGO), Thiodiglycolic Acid (TDG), Tiglyglycine (TG)
Hormones Comprehensive Panel 1 - 3 weeks
Hormones Comprehensive Plus Panel 1 - 3 weeks
Hormone Short Comprehensive Panel 1 - 3 weeks
Estradiol, Progesterone, Testosterone, DHEA, am/noon/evening/pm Cortisol Estrone, Estradiol, Estriol, Progesterone, Testosterone, DHEA, am/noon/evening/pm Cortisol Estradiol, Progesterone, Testosterone, DHEA, am /pm Cortisol
IgE Allergy Advanced Combined Test See IgE Food Allergy Advanced Test (93) and IgE Inhalant Allergy Advanced Test (69) for test descriptions. (93 / 69) 1 - 2 weeks
IgE Food Allergy Essentials Test (12) 1 - 2 weeks
Almond, Beef, Chicken, Corn, Egg White, Milk, Orange, Peanut, Shrimp, Soybean, Tomato, Wheat
IgE Food Allergy Basic Test (25) 1 - 2 weeks
IgE Food Allergy Advanced Test (93) 1 - 2 weeks
IgE Inhalant Allergy Basic Test (36) 1 - 2 weeks
IgE Inhalant Allergy Advanced Test (69) 1 - 2 weeks
Almond, Apple, Barley, Bean (White), Beef, Chicken, Chocolate, Corn, Egg (Whole), Garlic, Milk, Oat, Onion, Orange, Peanut, Pork, Potato, Rice, Shellfish Mix (Cod, Shrimp, Mussel, Tuna, Salmon), Soybean, Tomato, Tuna, Vegetable Mix (Green Bean, White Bean, Carrot, Potato), Wheat, Yeast (Bakers) Almond, Apple, Apricot, Asparagus, Avocado, Banana, Barley, Beef, Beet, Blueberry, Broccoli, Buckwheat, Cabbage, Cane Sugar, Carrot, Casein, Cashews, Celery, Cheese, Chicken, Coconut, Cod Fish, Cocoa, Coffee, Corn, Crab, Cranberry, Eggplant, Egg White, Egg Yolk, Flax, Garbanzo Bean, Garlic, Gluten, Goat’s Milk Cheese, Grape, Grapefruit, Green Bean, Green Pepper, Halibut, Hazelnut, Honey, Kidney Bean, Lamb, Lemon, Lentil, Lettuce, Lima Bean, Lobster, Mango, Milk, Millet, Mushroom, Oat, Onion, Orange, Papaya, Pea, Peach, Peanut, Pear, Pecan, Pineapple, Pinto Bean, Pistachio, Plum, Pork, Potato, Pumpkin, Radish, Raisin, Rice, Rye, Salmon, Sardine, Sesame, Shrimp, Soybean, Spinach, Strawberry, Sunflower, Sweet Potato, Tomato, Turkey, Tuna, Walnut, Watermelon, Wheat, Whey, Yogurt, Yeast (Bakers), Yeast (Brewers), Zucchini Alder (Speckled), Alternaria, Ash (White), Aspergillus, Beech (American), Bermuda Grass, Birch (Common Silver), Box Elder (Maple), Burning Bush, Cat, Cladosporium, Cocklebur, Cockroach, Cottonwood Tree, Dog, Elm (White), Hickory (White), House Dust, Lamb’s Quarters, Marsh Elder (Rough), Meadow Fescue, Mite (D. Farinae), Mugwort, Nettle, Oak (White), Orchard Grass/Cocksfoot, Penicillium, Pigweed, Pine Ponderosa, Plantain (English), Privet, Ragweed (Short), Rye (Perennial), Sheep Sorrel, Sycamore (American), Timothy Grass Acacia, Alder (Smooth), Alternaria, Amoxicillin, Ash (White), Aspergillus, Bahia Grass, Bermuda Grass, Bluegrass (Kentucky), Box Elder (Maple), Brome Grass, Candida, Cat, Cedar (Mountain), Cladosporium, Cocklebur, Cockroach, Corn (Cultivated), Cottonwood Tree, Cypress (Bald), Dockweed (Yellow), Dog, Elm (American and Fall Blooming), Ferret, Fescue (Meadow), Gerbil, Goldenrod, Hickory (White), House Dust, Iodine Bush, Johnson Grass, Lamb’s Quarters, Maple (Red), Marsh Elder (Rough), Mexican Tea, Mite (D. Farinae), Mouse, Mulberry (Red and White), Nettle, Oak (Live, White, and Red), Oats, (Cultivated), Oat Grass Tall, Pecan Tree, Penicillium, Pigweed (Spiny and Rough), Plantain (English), Poplar (White), Privet, Rabbit, Ragweed (Giant and Short), Rye (Cultivated), Rye Grass (Perennial), Salt Cedar, Salt Grass, Sheep Sorrel, Sweet Gum, Sycamore, Timothy Grass, Tree of Heaven, Walnut (Black), Western Water Hemp, Wheat (Cultivated), Willow (Black)
IgG Food Allergy Test w/ Candida (94) Almond, Apple, Apricot, Asparagus, Avocado, Baker’s Yeast (Saccharomyces cerevisiae), Banana, Barley, Beef, Beet, Blueberry, Brewer’s Yeast
(Saccharomyces cerevisiae),Broccoli, Buckwheat, Cabbage, Candida albicans, Cane Sugar, Carrot, Cashews, Casein, Celery, Cheese, Chicken, Cocoa, Coconut, Cod fish, Coffee, Corn, Crab, Cranberry, Eggplant, Egg White, Egg Yolk, Flax, Garbanzo Beans, Garlic, Gliadin, Goat’s Milk Cheese, Grape, Grapefruit, Green Bean, Green Pepper, Halibut, Hazelnut, Honey, Kidney Bean, Lamb, Lemon, Lentil, Lettuce, Lima bean, Lobster, Milk, Millet, Mozzarella Cheese, Mushroom, Oat, Onion, Orange, Papaya, Pea, Peach, Peanut, Pear, Pecan, Pineapple, Pinto Bean, Pistachio, Plum (Prune), Pork, Potato, Pumpkin, Radish, Rice, Rye, Salmon, Sardine, Sesame, Shrimp, Sorghum, Soybean, Spinach, Strawberry, Sunflower, Sweet Potato, Tomato, Tuna, Turkey, Wheat Gluten, Walnut, Watermelon, Wheat, Whey, Yogurt
1 - 2 weeks
IgG Food Allergy Test w/ Candida + IgE See IgG Food Allergy Test w/ Candida and IgE Food Allergy Essentials Test for test descriptions. Food Allergy Essentials Test 1 - 2 weeks
IgG Asian Food Allergy Test w/ Candida (94) 1 - 2 weeks
Immune Deficiency Profile 1 - 3 weeks
Kryptopyrrole Test
Abalone, Adzuki Bean, Almond, Apple, Bamboo Shoot, Banana, Barley, Beef, Black Pepper, Bonito, Buckwheat, Burdock (Gobo), Cabbage, Candida albicans, Carrot, Casein, Cauliflower, Celery, Cheese, Cherry, Chestnut, Chicken, Clam, Cocoa, Coconut, Coffee, Corn, Crab, Cucumber, Curry Powder, Duck, Egg, Eggplant, Garlic, Ginger, Grape, Green Bean, Green Pepper, Green Tea, Honey, Jack Mackerel, Kiwi, Kombu (Kelp), Lamb, Laver (Nori), Lettuce, Lotus Root, Mackerel, Mango, Melon, Milk, Miso, Mushroom-Enoki, Mushroom-Shiitake, Mustard, Oat, Olive, Onion, Oolong Tea, Orange, Oyster, Pacific Saury, Pea, Peach, Peanut, Pear, Pineapple, Pistachio, Pork, Potato, Pumpkin, Radish-Daikon, Red Pepper, Rice, Rye, Salmon, Sardine, Seaweed (Wakame), Sesame, Shrimp, Soybean, Spinach, Squid, Strawberry, Sunflower, Sweet Potato, Tomato, Tuna, Vanilla Bean, Wheat, Wheat Gluten, Whey, Yeast (Brewer’s), Yogurt Immunoglobulins IgA, IgM, IgE, IgG and IgG Subclasses 1, 2, 3 and 4, and Zinc Kryptopyrrole
2 - 3 weeks
Metals Fecal Test (13) 2 - 3 weeks
Metals Hair Test (39)
Toxic: Antimony, Arsenic, Beryllium, Bismuth, Cadmium, Copper, Lead, Mercury, Nickel, Platinum, Thallium, Tungsten, Uranium Nutritional: Calcium, Magnesium, Sodium, Potassium, Copper, Zinc, Manganese, Chromium, Vanadium, Molybdenum, Boron, Iodine, Lithium, Phosphorus, Selenium, Strontium, Sulfur, Barium, Cobalt, Iron, Germanium, Rubidium, Zirconium. Ratios: Calcium/Magnesium, Sodium/Potassium, Zinc/Copper, Zinc/Cadmium, Calcium/Phosphorus Toxic: Aluminum, Antimony, Arsenic, Beryllium, Bismuth, Cadmium, Lead, Mercury, Platinum, Thallium, Thorium, Uranium, Nickel, Silver, Tin, Titanium
2 - 3 weeks
Metals Red Blood Cell Test (18) 2 - 3 weeks
Metals Urine Test (37) 2 - 3 weeks
Metals Whole Blood Test (20) 2 - 3 weeks
Microbial Organic Acids Test (MOAT) (21) 1 - 2 weeks
Microbial Organic Acids Test + Yeast Culture w/ Sensitivity Test Combo 2 - 3 weeks
Organic Acids Test (OAT) (74) 1 - 2 weeks
Organic Acids Test + Amino Acids Urine Test Combo
Nutritional: Boron, Chromium, Calcium, Copper, Iron, Magnesium, Manganese, Molybdenum, Phosphorus, Potassium, Selenium, Vanadium, Zinc Toxic: Arsenic, Cadmium, Lead, Mercury, Thallium Nutritional: Boron, Calcium, Chromium, Cobalt, Copper, Iron, Magnesium, Manganese, Molybdenum, Phosphorus, Potassium, Selenium, Sodium, Strontium, Sulfur, Vanadium, and Zinc Toxic: Aluminum, Antimony, Arsenic, Barium, Beryllium, Bismuth, Cadmium, Cesium, Gadolinium, Lead, Mercury, Nickel, Palladium, Platinum, Tellurium, Thallium, Thorium, Tin, Tungsten, Uranium Nutritional: Calcium, Copper, Lithium, Magnesium, Manganese, Molybdenum, Selenium, Strontium, Zinc Toxic: Arsenic, Barium, Cadmium, Cobalt, Lead, Mercury, Nickel, Platinum, Silver, Thallium, Uranium Citramalic, 5-Hydroxymethyl-2-Furoic, 3-Oxoglutaric, Furan-2,5-Dicarboxylic, Furancarbonylglycine, Tartaric, Arabinose, Carboxycitric, Tricarballylic, 2Hydroxyphenylacetic, 4-Hydroxyphenylacetic, 4-Hydroxybenzoic, 4-Hydroxyhippuric, HPHPA (Clostridia marker), 4-Cresol, DHPPA (beneficial bacteria), Hippuric, 3-Indoleacetic, 3-Hydroxy-3-methylglutaric, 2-Hydroxyhippuric, Creatinine See Microbial Organic Acids Test and Yeast Culture w/ Sensitivity Test for test descriptions. Citramalic, 5-Hydroxymethyl-2-furoic, 3-Oxoglutaric, Furan-2,5-dicarboxylic, Furancarbonylglycine, Tartaric, Arabinose, Carboxycitric, Tricarballylic, 2-Hydroxyphenylacetic, 4Hydroxyphenylacetic, 4-Hydroxybenzoic, 4-Hydroxyhippuric, Hippuric, 3-Indoleacetic, Succinic, HPHPA (Clostridia marker), 4-Cresol (C. difficile), DHPPA (beneficial bacteria), Glyceric, Glycolic, Oxalic, Lactic, Pyruvic, 2-Hydroxybutyric, Fumaric, Malic, 2-Oxoglutaric, Aconitic, Citric, Homovanillic Acid (HVA), Vanillmandelic Acid (VMA), HVA/VMA Ratio, 5-Hydroxyindoleacetic (5-HIAA), Quinolinic, Kynurenic, Quinolinic / 5-HIAA Ratio, Uracil, Thymine, 3-Hydroxybutyric, Acetoacetic, 4-Hydroxybutyric, Ethylmalonic, Methylsuccinic, Adipic, Suberic, Sebacic, Methylmalonic (Vitamin B12), Pyridoxic (Vitamin B6), Pantothenic (Vitamin B5), Glutaric (Vitamin B2-Riboflavin), Ascorbic (Vitamin C), 3-Hydroxy-3-methylglutaric (Vitamin Q10-CoQ10), N-Acetylcysteine (Glutathione precursor and chelating agent), Methylcitric (Vitamin H-Biotin), Pyroglutamic, Orotic, 2Hydroxyhippuric, 2-Hydroxyisovaleric, 2-Oxoisovaleric, 3-Methyl-2-oxovaleric, 2-Hydroxyisocaproic, 2-Oxoisocaproic, 2-Oxo-4-methiolbutyric, Mandelic, Phenyllactic, Phenylpyruvic, Homogentisic, 4-Hydroxyphenyllactic, N-Acetylaspartic, Malonic, 3-Methylglutaric, 3-Hydroxyglutaric, 3-Methylglutaconic, Phosphoric, Creatinine See Organic Acids Test and Amino Acids Urine Test for test descriptions.
1 - 3 weeks
Organic Acids Test + IgG Food Allergy See Organic Acids Test and IgG Food Allergy Test w/ Candida for test descriptions. Test w/ Candida Combo 1 - 3 weeks
Organic Acids Test + Yeast Culture w/ See Organic Acids Test and Yeast Culture w/ Sensitivity Test for test descriptions. Sensitivity Test Combo 2 - 3 weeks
Phospholipase A2 Activity Test 1 - 2 weeks
Porphyrins Profile Prealbumin Test
(2 - 3 weeks) (1 - 3 weeks)
Streptococcus Antibodies Profile 1 - 3 weeks
Uric Acid Test (1 - 3 weeks)
Phospholipase A2 Activity Coproporphyrin I and III (CP), Heptacarboxy (7-CP), Hexacarboxy (6-CP), Pentacarboxy (5-CP), Precoproporphyrin (PreCP), Uroporphyrins (UP) Prealbumin DNase antibodies in serum (ADB); Antistreptolysin O titer (ASO) Uric Acid, Creatinine
Vitamin D Test: Serum 25-Hydroxyvitamin D2 (ergocalciferol), 25-Hydroxyvitamin D3 (cholecalciferol) Vitamin D Test: Dried Blood Spot (DBS) Serum: 2 - 3 weeks DBS: 3 - 4 weeks
Yeast Culture w/ Sensitivity Test 2 - 3 weeks
Yeast (Mycology) culture: 48 possible yeast and fungal species; Yeast (microscopy - visible presence of yeast cells); Yeast sensitivity to: Berberine, Caprylic Acid, Uva Ursi , Tannic Acid, Oregano, Undecylenic Acid, Citrus Seed Extract, Nystatin, Fluconazole, Itraconazole, Ketoconazole
Zinc Test (2 - 3 weeks)
Zinc
PLEASE NOTE: *SST tubes are not sent in international test kits - Navy blue top tubes with (no additive) are provided in international test kits. Revised 07/10/15
Turn-Around-Times and Specimen Collection
Turn-Around-Times and Specimen Collection
4
Turn-Around-Times and Specimen Collection
70 mL Urine Collection Cup 70 mL Urine Collection Cup 4 Tubes 4 Tubes 4 Tubes 1 Serum‐Separator tube (gold top) 2 Serum‐Separator tube (gold top) 3 Serum‐Separator tubes (gold top) 2 Serum‐Separator tubes (gold top) 3 Serum‐Separator tubes (gold top) 6 Serum‐Separator tubes (gold top) 1 Serum‐Separator tube (gold top) No tubes / DBS Blood Collection Card
GPL‐TOX (Toxic Organic Chemical Profile)
Gluten / Casein Peptides Test
Hormones Comprehensive Panel
Hormones Comprehensive Plus Panel
Hormones Short Comprehensive Panel
IgE Food Allergy Essentials Test (12) IgE Food Allergy Basic Test (25) IgE Food Allergy Advanced Test (93) IgE Inhalant Allergy Basic Test (36) IgE Inhalant Allergy Advanced Test (69) IgE Allergy Advanced Combined Test (93/69) IgG Food Allergy Test w/ Candida ‐ Serum IgG Food Allergy Test w/ Candida ‐ DBS IgG Food Allergy Test w/ Candida + IgE Food Allergy Essentials Test Immune Deficiency Profile Kryptopyrrole Test (USA only) Metals Whole Blood Test
2 Blue‐top tubes (Potassium EDTA) 70 mL Urine Collection Cup
Metals Urine Test
2 Blue‐top tube (no additive) Amber plastic vial (w/ additive), frozen, pack on ice 1 Blue‐top tube (Potassium EDTA) 1 white or blue‐capped tube provided, no more than 7 days old Collect from nape of the neck
Metals Red Blood Cell Test
Metals Hair Test
Metals Fecal Test
1 Blue‐top tube (no additive) 2 Blue‐top tube (no additive) 1 Serum‐Separator tube (gold top) No tubes / DBS Blood Collection Card 1 Serum‐Separator tube (gold top)
Copper Test Copper / Zinc Profile C‐Reactive Protein Test (hs‐CRP) DNA Methylation Pathway Profile Ferritin Test (only available in panels)
1 Serum‐Separator tube (gold top)
2 yellow, 1 green, 1 white (frozen), no more than 5 days old
1 Serum‐Separator tube (gold top) 1 Blue‐top tube (no additive) 1 Serum‐Separator tube (gold top) ‐ For US 1 Blue‐top tube (no additive) ‐ Canada Gel Pouch
Comprehensive Stool Analysis (CSAP2)
Comprehensive Fatty Acids Test (USA & Canada)
Celiac Disease Test Ceruloplasmin Test
Amino Acid Urine Test (43)
70 mL Urine Collection Cup, Blue specimen vial to the fill line, pack on ice
2 Serum‐Separator tube (gold top) 1 Lavender‐top(EDTA) tube; (overnight fast)mixed with acid tube
Advanced Cholesterol Profile
Amino Acid Plasma Test (USA only)
Type of Tube / Vial
Test
First Morn. Urine, 24 hr or timed urine ‐ Freeze Sample
Packed Cells
Hair
Stool
Serum Urine Whole Blood
Serum
Serum Serum Serum Dried Blood Spot Serum First Morning Urine ‐ Freeze Sample First Morning Urine ‐ Freeze Sample Collect saliva Four (4) times in one day Collect saliva Four (4) times in one day Collect saliva Four (4) times in one day Serum Serum Serum Serum Serum Serum Serum Dried Blood Spot
Stool
Serum
Serum Serum
First Morning Urine or 24 hr Urine ‐ Freeze Sample
Plasma
Serum
Type of Specimen
2 mL
Requested Amount 4 mL
Fill Line
4 mL 10 mL 7 mL
3 mL
40 mL
50 mL
.25 grams 1 gram 2 mL Pk 4 mL Pk Cells Cells
1/2 full
3 mL 8 mL 7 mL
2 mL
Each Tube 3/4 full Each Tube 3/4 full Each Tube 3/4 full 2 mL 5 mL 8 mL 5 mL 8 mL 12 mL 1 mL 5 spots
Each Tube 3/4 full Each Tube 3/4 full Each Tube 3/4 full 1 mL 2 mL 6 mL 3 mL 5 mL 10 mL .5 mL 3 spots
2 ‐ 3 weeks
2 ‐ 3 weeks
2 ‐ 3 weeks
2 ‐ 3 weeks
1 ‐ 3 weeks 2 ‐ 3 weeks 2 ‐ 3 weeks
1 ‐ 2 weeks
1 ‐ 2 weeks 1 ‐ 2 weeks 1 ‐ 2 weeks 1 ‐ 2 weeks 1 ‐ 2 weeks 1 ‐ 2 weeks 1 ‐ 2 weeks 1 ‐ 2 weeks
7 ‐ 10 business days
7 ‐ 10 business days
7 ‐ 10 business days
1 ‐ 2 weeks
10 mL 5 mL
1 ‐ 3 weeks 1 ‐ 3 weeks 1 ‐ 3 weeks 4 ‐5 Weeks 1 ‐ 3 weeks
2 ‐ 4 weeks
1 ‐ 3 weeks
1 ‐ 2 weeks
3 mL 4 mL 1 mL 5 spots 3 mL
Fill Line
2 mL
1 ‐ 3 weeks 1 ‐ 3 weeks
2 ‐ 4 Weeks
2 ‐ 4 Weeks
2 ‐ 4 Weeks
Turn Around Time
10 mL
5 mL
2 mL 3 mL .5 mL 3 spots 2 mL
1 mL
20 mL, blue 25 mL, blue vial to fill vial to fill line line 2 mL 3 mL 1 mL 2 mL
1 mL
Absolute Minimum 3 mL
Turn Around Times & Specimen Requirements
70 mL Urine Collection Cup 70 mL Urine Collection Cup 70 mL Urine Collection Cup 1 Serum‐Separator tube (gold top) 1 Amber plastic vial, no additive (light sensitive) 1 Serum‐Separator tube (gold top) 70 mL Urine Collection Cup
Microbial Organic Acids Test (MOAT) (20)
Organic Acids Test (72)
Phospholipase A2 Activity Test
Prealbumin Test Porphyrins Profile Streptococcus Antibodies Profile
Uric Acid Test (24 Hr or Random)
First Morning Urine ‐ Freeze Sample First Morning Urine ‐ Freeze Sample First Morning Urine ‐ Freeze Sample Serum Urine Serum First Morning Urine or 24 hr ‐ Freeze Sample
Type of Specimen
10 mL
1 mL 10 mL 3 mL
.5 mL 5 mL 2 mL 5 mL
10 mL
10 mL
10 mL
Requested Amount
5 mL
5 mL
5 mL
Absolute Minimum
1 ‐ 3 weeks
1 ‐ 3 weeks 2 ‐ 3 weeks 1 ‐ 3 weeks
1 ‐ 2 weeks
1 ‐ 2 weeks
1 ‐ 2 weeks
Turn Around Time
Yeast Culture w/ Sensitivity Test
1 green or orange‐capped tube provided, no more than 7 2 ‐ 3 weeks Stool Fill Line days old Vitamin D Test ‐ Serum 1 Serum‐Separator tube (gold top) Serum 1 mL 2 mL 2 ‐ 3 weeks Vitamin D Test ‐ DBS No tubes / DBS Blood Collection Card Dried Blood Spot 3 spots 5 spots 3 ‐ 4 weeks Zinc Test 1 Blue‐top tube (no additive) Serum 1 mL 2 mL 1 ‐ 3 weeks Please note: For International Test Kits ‐ Blue‐Top Tubes are sent in place of Serum‐Separator Tubes (gold top). Updated 7/13/15
Type of Tube / Vial
Test
Turn Around Times & Specimen Requirements
Specimen Collection & Shipping Instructions The following test instructions are available for download on our website at www.greatplainslaboratory.com/home/eng/sample.asp. All test instructions are shipped with each kit. • • • • • • • • • • • • • •
Blood Tests & Phlebotomy Blood Draw Instructions Comprehensive Stool Analysis (Thermo bag version) Comprehensive Stool Analysis (Styrofoam version) DMSA Challenge Test for Heavy Metal Poisoning Dried Blood Spot (DBS) Test Metals Fecal Test Metals Hair Test Organic Acids Test (OAT) + IgG Food Allergy w/ Candida Test Combo (DBS) Organic Acids Test (OAT) + IgG Food Allergy w/ Candida Test Combo (Serum) Organic Acids Test (OAT) + Yeast Culture w/ Sensitivity Test Combo Urine Tests (Thermo bag version) Urine Tests (Styrofoam version) Yeast Culture w/ Sensitivity Test Test Panels Instructions (U.S. Only)
Blood Draw Service Options If you do not have a phlebotomist and are interested in ordering blood tests:
We recommend using Any Lab Test Now. Visit www.anylabtestnow.com/locations to find a location near you.
For the Los Angeles and Orange County Areas: (MPS) Mobile Phlebotomy Services can do blood draw from your home. The cost is $80. Call 909-985-5562 to make appointment. Standard hours of operation are 6:00 a.m. to 3:00 p.m.
Other options (We recommend contacting these service providers first as we cannot guarantee that they will provide blood draw services):
LabCorp or Quest Diagnostics
We recommend that physicians set up an account and advise the laboratory prior to referring patients for blood draw services. We also recommend taking a GPL test kit to the laboratory and discussing the process together.
Local Hospital Children’s Hospital Urgent Care Local Medical School Suggestions from patient’s insurance company An associate in another office that has a phlebotomist
Phlebotomists customarily charge a fee for the blood draw, which most insurances companies cover. For the IgG Food Allergy Test, try the popular and convenient dry blood spot instead that you can perform in-home.
Turn-Around-Times and Specimen Collection
Insurance Billing, CPT & ICD-9 Codes
Insurance Billing, CPT & ICD-9 Codes
5
Insurance Billing, CPT & ICD-9 Codes
Revised 7/10/15
Insurance Overview Provider Blue Cross Blue Shield (BCBS)
Contracted Plans BCBS of Illinois BCBS of Kansas City PPO BCBS of Minnesota BCBS of Vermont
BCBS of Illinois: Comprehensive Stool Analysis not covered* Capital Blue Cross, Highmark, and Blue Shield of California: IgG Food Allergy Test w/ Candida not covered*
Blue Cross of Idaho PPO
Federal Employee Program
Blue Shield of California* *Blue Shield Covered
Highmark Blue Shield of Pennsylvania
California and plans that begin with ID# “XEK” are Non-Contracted Plans, see guidelines below.
Keystone Health Plan West - Pennsylvania (HMO) Highmark West Virginia
Capital Blue Cross of Pennsylvania
Contracted Insurance Providers
Restrictions
Carefirst BCBS – includes Maryland, Washington DC, and parts of Northern Virginia
Tricare
Tricare Prime Tricare Standard Tricare for Life
Medicare
Medicare Medicare Advantage PPO
*These tests must be paid in full at the time of Service
Tests not covered: Microbial Organic Acids Test, Porphyrins Profile, Kryptopyrrole Test, Comprehensive Fatty Acids Test. Hormones Panels cannot be billed for Tricare South Medicare Advantage HMO For non-eligible tests, refer to the Advance Beneficiary Notice (ABN) included in the Test Requisition Form
Medicare/Medicare Advantage does not pay for tests for which the documentation, including the patient record, does not support that the tests were reasonable or necessary, and does not cover routine screening tests. It is the responsibility of the ordering physician to document and maintain the medical necessity of each test in the patient’s medical record. Requirements: Comprehensive Stool Analysis requires payment of $94.44 Signed ABN required (see Test Requisition Form)
Provider Non-contracted Blue Cross Blue Shield (BCBS) Anthem Blue Cross of California Blue Cross of Massachusetts HMO Cigna Harvard Pilgrim Tufts United Healthcare
Non-Contracted Plans
Non-Covered Tests
Eligibility All Non-Contracted plans will require a 20% down payment (see price list) Any restricted plans or tests must pay in full at the time of service
Restrictions Contracted Insurance Providers and Non-Covered Plans IgG Food Allergy Test not covered for: Anthem BCBS of California BCBS of North Carolina
The Great Plains Laboratory files the insurance claim on behalf of the patient. Some insurance companies provide payment and Explanation of Benefits (EOB) to the patients directly. If the patient is paid directly, the endorsed check and EOB must be forwarded to The Great Plains Laboratory (endorse back of check: “Pay to the order of The Great Plains Laboratory” and sign).
Amino Acids Plasma or Urine Test
DNA Methylation Pathway Profile
Kryptopyrrole Test
Phospholipase A2 Activity Test
GPL-TOX (Toxic Organic Chemical Profile)
We are not in-network with any of these plans and will not bill to these insurance carriers. Full cash price payment required and must be submitted with specimens. A receipt will be sent to the patient. HMO plans (except those listed Aetna UMR above) All non-eligible plans (see above) United Healthcare of the River Valley
Non-Covered Plans
BCBS of Florida BCBS of Iowa BCBS of Arizona BCBS of Texas
Humana
Wellmark BCBS of Iowa
Medicaid Silver Direct Access (a plan under Anthem Blue Cross of California)
Wellmark BCBS of South Dakota
GEHA
For any questions regarding insurance coverage, please call 913-341-8949 or 913-754-0459 Always call your insurance provider to confirm benefits as insurance coverage is subject to change. Patients are responsible for any deductibles, copayments, cost shares, coinsurance, or balance. If for any reason your insurance company deems your lab work as a noncovered or medically unnecessary service, you will be responsible for the full amount of the charge. We are currently applying for in-network coverage with several individual BCBS state programs. Please check our website for updated information at www.GPL4U.com/Insurance_Overview. Also available at this location is our insurance coverage verification guide to assist in determining coverage. NOTE: Insurance is filed in the state where the referring physicians NPI is registered, or where the referring physician's NPI is currently located. Page 1 of 1
Revised 07/10/15
Guide to Determining Insurance Coverage By calling your insurance provider, you can verify your coverage and gather information to determine any out-of-pocket expenses. This is not a guarantee of coverage or reimbursement from your insurance plan; rather, it is meant to be a guide to determining whether to file insurance or to pay cash price. The Great Plains Laboratory will file insurance for both contracted and non-contracted insurance plans (see insurance overview for participating carriers).
Before You Call Have the following ready when you call your insurance company: 1) Your Insurance Card – You will need the ID number and group number 2) CPT (Current Procedural Terminology) Codes – On the next page of this guide 3) Diagnosis (ICD-9) Codes – Must obtain these from your physician 4) The Great Plains Laboratory, Inc. Tax ID number is 48-1192412 5) The Great Plains Laboratory, Inc. NPI number is 1942282496
When You Call 1) Document Your Call Insurance Representative’s Name:__________________Date of Call:____________Time of Call:______
2) Verify Coverage A) Tell the representative that you would like to verify coverage of laboratory tests. If they ask if this is medical or routine, inform them it is medical. B) Provide the gathered information above (see “Before You Call”)
3) Ask the following questions: A) B) C) D)
Is the test covered? � Yes � No If the answer is “no” you will need to pay the discounted cash price How much of my deductible is remaining? $____________ What is my co-insurance? (Usually 20%-50%) __________ How much of my annual out-of-pocket expense is remaining? $____________
If your deductible or co-insurance is higher than the total cash amount, it is recommended to pay the cash price then file with your insurance company once you’ve received your billing statement from the Great Plains Laboratory. If the test is not covered, then pay the lower cash price.
Insurance Billing, CPT & ICD-9 Codes
CPT Codes Revised 5/23/13
Test
CPT Code(s)
Comprehensive Hormone Panel
82670 84144 84402 82626 82530*4
Comprehensive Plus Hormone Panel
82679 82670 82677 84144 84402 82626 82530*4 82272† 82492† 82656 83516† 83631 83986 85549† 87045 87046 87102 87177*2 87209*2 87328 87329 89125 89160†
Advanced Cholesterol Profile – Serum Amino Acids Plasma or Urine Test C-Reactive Protein Test (hs-CRP) – Serum CBC Test w/ Differential – Serum Celiac Disease Test – Serum Ceruloplasmin Test – Serum Comprehensive Fatty Acids Test – Serum
Comprehensive Stool Analysis – Stool Copper Test – Serum Copper / Zinc Profile – Serum Gluten / Casein Peptides Test – Urine GPL3
GPL4-DBS
GPL4-Serum Hormones Comprehensive Panel Hormones Comprehensive Plus Panel Hormones Short Comprehensive Panel IgE Allergy Advanced Combined Test (93/69) – Serum IgE Food Allergy Basic Test (25) – Serum IgE Food Allergy Advanced Test (93) – Serum IgE Inhalant Allergy Basic Test (36) – Serum IgE Inhalant Allergy Advanced Test (69) – Serum IgG Food Allergy Test w/ Candida (94) – Serum/DBS IgG Asian Food Allergy Test w/ Candida (94) – Serum/DBS Immune Deficiency Profile – Serum Metals Fecal Test (13) Metals Hair Test (39) Metals Red Blood Cell Test (18) Metals Urine Test (38) Metals Whole Blood Test (20) Microbial Organic Acids Test (MOAT) (21) – Urine Organic Acids Test (OAT) (74) – Urine OAT + Amino Acids Urine Test Combo - Urine OAT + IgG Food Allergy Test w/ Candida Combo – Urine & Serum/Dried Blood Spot (DBS) Porphyrins Profile – Urine Prealbumin Test – Serum Short Comprehensive Hormone Panel Streptococcus Antibodies Profile – Serum Uric Acid Test – Urine Vitamin D Test – Serum/DBS Yeast Culture w/ Sensitivity Test – Stool Zinc Test – Serum
Insurance Billing, CPT & ICD-9 Codes
82172*2 82465 83090 83695 83718 82139*1 82140 82492 84540 86141 85027 82492 82390 82544*30 No Medicare Coverage
† No Medicare Coverage
82525 82390 82525 84630 82570 83519*2 No Medicare Coverage 82108 82131 82300 82507 82525 82570 83018*28 83150 83497 83605 83655 83735 83785 83825 83885 83921*63 83945 84100 84207 84210 84255 84585 84591 84630 86001*93 86628 86671*2 No Medicare Coverage 82108 82131 82300 82306 82507 82525 82542 82570 83018*28 83150 83497 83605 83655 83735 83785 83825 83885 83921*63 83945 84100 84207 84210 84255 84585 84591 84630 86001*93 86628 86671*2 No Medicare Coverage 82131 82175 82300 82306 82310 82495 82507 82525 82542 82570 83015 83018*4 83150 83497 83605 83655 83735 83785 83825 83921*63 83945 84100 84132 84207 84210 84255 84585 84591 84630 86001*93 86628 86671*2 No Medicare Coverage 82670 84144 84402 82626 82530*4 82679 82670 82677 84144 84402 82626 82530*4 82670 84144 84402 82626 82530*2 86003*162 No Medicare Coverage 86003*25 No Medicare Coverage 86003*93 No Medicare Coverage 86003*36 No Medicare Coverage 86003*69 No Medicare Coverage 86001*93 86628 86671*2 No Medicare Coverage 86001*93 86628 86671*2 No Medicare Coverage 82784 82785 82787*4 84630 82175 82300 82525 83015 83655 83825 83885 No Medicare Coverage 82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630 No Medicare Coverage 82175 82300 82310 82495 82525 83015 83018*4 83655 83735 83785 83825 84100 84132 84255 84630 No Medicare Coverage 82108 82175 82300 82495 82525 82570 83018 83540 83655 83735 83785 83825 83885 84100 84133 84255 84300 84630 No Medicare Coverage 82310 82495 82525 83018*7 83655 83735 83825 84132 84255 84285 84295 84630 No Medicare Coverage 82570 83921*20 82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591 82131 82139*1 82140 82507 82492 82570 83150 83497 83605 83921*63 83945 84207 84210 84540 84585 84591 86001*93 86628 86671 82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591 No Medicare Coverage 84120*6 84134 82670 84144 84402 82626 82530*2 83883 86215 84560 82306 82542 No Medicare Coverage 87102 87106 87184 87220 84630
CPT Codes: Test Panels Basic Autism Panel Comprehensive Stool Analysis
82272† 82492† 82656 83516† 83631 83986 85549† 87045 87046 87102 87177*2 87209*2 87328 87329 89125 89160† † No Medicare Coverage
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
No Medicare Coverage No Medicare Coverage
No Medicare Coverage
Comprehensive Autism Panel Advanced Cholesterol Profile
82172*2 82465 83090 83695 83718
Comprehensive Stool Analysis
82272† 82492† 82656 83516† 83631 83986 85549† 87045 87046 87102 87177*2 87209*2 87328 87329 89125 89160† † No Medicare Coverage
Copper/Zinc Profile
82390 82525 84630
Ferritin Test
82728
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Immune Deficiency Profile
82784 82785 82787*4 84630
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Streptococcus Antibodies Profile
83883 86215
Vitamin D Test
82306 82542
No Medicare Coverage No Medicare Coverage
No Medicare Coverage
No Medicare Coverage
Basic AD(H)D Panel Comprehensive Fatty Acids Test
82544*30
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Page 1 of 5
No Medicare Coverage No Medicare Coverage No Medicare Coverage
No Medicare Coverage
Revised 01/15/14
Insurance Billing, CPT & ICD-9 Codes
Comprehensive AD(H)D Panel Advanced Cholesterol Profile
82172*2 82465 83090 83695 83718
Amino Acids Urine Test
82139*1 82140 82492 84540
Comprehensive Fatty Acids Test
82544*30
Comprehensive Stool Analysis
82272 82492† 82656 83516† 83631 83986 85549† 87045 87046 87102 87177*2 87209*2 87328 87329 89125 89160† † No Medicare Coverage
Copper/Zinc Profile
82390 82525 84630
Ferritin Test
82728
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
No Medicare Coverage
†
No Medicare Coverage No Medicare Coverage
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
No Medicare Coverage
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Streptococcus Antibodies Profile
83883 86215
Vitamin D Test
82306 82542
No Medicare Coverage
Basic Tourette’s & Tics Panel Advanced Cholesterol Profile
82172*2 82465 83090 83695 83718
Ferritin Test
82728
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
No Medicare Coverage
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
No Medicare Coverage
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Streptococcus Antibodies Profile
83883 86215
Comprehensive Tourette’s & Tics Panel Advanced Cholesterol Profile
82172*2 82465 83090 83695 83718
Amino Acids Urine Test
82139*1 82140 82492 84540
Comprehensive Stool Analysis
82272† 82492† 82656 83516† 83631 83986 85549† 87045 87046 87102 87177*2 87209*2 87328 87329 89125 89160† † No Medicare Coverage
Copper/Zinc Profile
82390 82525 84630
Ferritin Test
82728
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Immune Deficiency Profile
82784 82785 82787*4 84630
Metals Hair Test
No Medicare Coverage No Medicare Coverage
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
No Medicare Coverage
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Streptococcus Antibodies Profile
83883 86215
Vitamin D Test
82306 82542
No Medicare Coverage
Page 2 of 5
Insurance Billing, CPT & ICD-9 Codes
Revised 01/15/14
Basic Fibromyalgia & CFS Panel Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
No Medicare Coverage No Medicare Coverage
No Medicare Coverage
Comprehensive Fibromyalgia & CFS Panel Amino Acids Urine Test
82139*1 82140 82492 84540
C-Reactive Protein Test
86141
Comprehensive Stool Analysis
82272† 82492† 82656 83516† 83631 83986 85549† 87045 87046 87102 87177*2 87209*2 87328 87329 89125 89160† † No Medicare Coverage
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Vitamin D Test
82306 82542
No Medicare Coverage No Medicare Coverage
No Medicare Coverage
No Medicare Coverage
Basic Wellness Panel Comprehensive Fatty Acids Test
82544*30
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
No Medicare Coverage No Medicare Coverage
No Medicare Coverage
Comprehensive Wellness Panel Advanced Cholesterol Profile
82172*2 82465 83090 83695 83718
Amino Acids Urine Test
82139*1 82140 82492 84540
Comprehensive Fatty Acids Test
82544*30
Copper/Zinc Profile
82390 82525 84630
Ferritin Test
82728
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Vitamin D Test
82306 82542
Page 3 of 5
No Medicare Coverage
No Medicare Coverage No Medicare Coverage
No Medicare Coverage
No Medicare Coverage
Revised 01/15/14
Insurance Billing, CPT & ICD-9 Codes
Basic Mental Health Panel Amino Acids Urine Test
82139*1 82140 82492 84540
Comprehensive Fatty Acids Test
82544*30
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
No Medicare Coverage No Medicare Coverage No Medicare Coverage
No Medicare Coverage
Comprehensive Mental Health Panel Advanced Cholesterol Profile
82172*2 82465 83090 83695 83718
Amino Acids Urine Test
82139*1 82140 82492 84540
Comprehensive Fatty Acids Test
82544*30
Comprehensive Stool Analysis
82272† 82492† 82656 83516† 83631 83986 85549† 87045 87046 87102 87177*2 87209*2 87328 87329 89125 89160† † No Medicare Coverage
Copper/Zinc Profile
82390 82525 84630
Gluten/Casein Peptides Test
82570 83519*2
IgG Food Allergy Test w/ Candida
86001*93 86628 86671*2
Metals Hair Test
82108 82300 82525 83018*28 83655 83735 83785 83825 83885 84100 84255 84630
Organic Acids Test
82131 82507 82570 83150 83497 83605 83921*63 83945 84207 84210 84585 84591
Vitamin D Test
82306 82542
No Medicare Coverage
No Medicare Coverage No Medicare Coverage
No Medicare Coverage
No Medicare Coverage
Page 4 of 5
Insurance Billing, CPT & ICD-9 Codes
Revised 01/15/14
ICD-9 Codes Abnormal chemistry
790.6
Abnormal weight gain
783.1
Abnormal findings
796
ADD, without hyperactivity
314
ADHD, with hyperactivity
314.01
Adrenal disorder
255.8
Adrenal hypofunction
255.5
Allergic rhinitis
477
Allergic rhinitis
477
Allergies
995.3
Anxiety
300
Anxiety, generalized
300.02
Asthma, unspecificied; with acute exacerbation
493.92
Asthma, unspecified, with status asthmaticus
493.91
Asthma, unspecified;unspecified
493.9
Autoimmune disease
279.4
Bipolar
296.8
Candidiasis (insurance usually asks for two numbers)
112; 112.85
Celiac
579
Chronic fatigue syndrome
780.71
Constipation
564
Corticoadrenal insufficiency
255.4
Crohns
555
Delayed milestones
783.42
Depression
311
Depression, neurotic
300.4
Depression, recurrent
296.32
Depression psychosis, unspecified
296.2
Dermatitis
692.4
Diarrhea
787.91
Disorder of thyroid
246.9
Disorders of amino-acid transport and metabolism
270
Disorders of urea cycle metabolism
270.6
Disturbances of sulphur-bearing amino-acid metabolism
270.4
Dysmenorrhea
625.3
Endocrine disorder
259.9
Fatigue, weakness and lethargy
780.79
Please note that these change often and may need to be verified.
Revised 1/1/10
Insurance Billing, CPT & ICD-9 Codes
Fibromyositis/myalgia
729.1
Flatulence/bloating
787.3
Following psychotherapy and other treatment for mental disorder
V66.3
Following psychotherapy and other treatment for mental disorder
V67.3
Food allergy
693.1, 692.5
Functional diarrhea
564.5
Gastroenteritis, diarrhea
558.9
Gastrointestinal symptoms
787.9
Headache
784
Hyperglycemia
790.29
Hyperlipidemia
272.4
Hyperlipidemia, mixed
272.2
Hypersomnia due to mental disorder
327.15
Hypersomnia with sleep apnea
780.53
Hypoglycemia
251.2
Hypothyroidism
244.9
Immune disorders
279.9
Immunodeficiency, unspecified
279.03
Insomnia
780.52
Insomnia due to mental disorder
327.02
Irritable bowel syndrome
564.1
Irritable colon (Colitis)
564.1
Lipoprotein deficiencies
272.5
Malabsorption
579.9
Malabsorption of carbohydrates metabolism disorder
277.9
Metal Toxicity
985.9
Migraine, classical
346
Migraine, variants
346.2
Nutritional deficiency, unspecified
269.9
Obesity
278
Obesity, morbid
278.01
Observation for suspected mental condition
V71.09
Other mental disorders
V11.8
Other mental problems
V40.2
Other specified drug-induced mental disorders
292.8
Other specified mental disorders and developmental handicaps
V79.8
Other specified transient mental disorders due to conditions classified elsewhere
293.8
Other suspected mental condition
V71.09
Personal history of mental disorder
V11.8
Please note that these change often and may need to be verified.
Revised 1/1/10
Insurance Billing, CPT & ICD-9 Codes
Rhinitis due to pollen
477
Special screening for mental disorders and developmental handicaps
V79
Stomach dysfunction
536.9
Unspecified disorder of amino-acid metabolism
270.9
Unspecified disorder of calcium metabolism
275.4
Unspecified disorder of carbohydrate transport and metabolism
271.9
Unspecified disorder of lipoid metabolism
272.9
Unspecified disorder of metabolism
277.9
Unspecified disorder of mineral metabolism
275.9
Unspecified mental disorder and developmental handicap
V79.9
Unspecified mental or behavioral problem
V40.9
Unspecified mental retardation
319
Please note that these change often and may need to be verified.
Revised 1/1/10
Insurance Billing, CPT & ICD-9 Codes
Sample Test Requisition Form
Sample Test Requisition Form
6
Sample Test Requisition Form
800-288-0383 www.GPL4U.com
Test Requisition Form Information in RED is required to process sample.
Please print clearly.
Patient Information First Name
Last Name
Address
City
Country
□ Male □ Female
Phone
Date of Birth (MM/DD/YYYY)
State
Zip
Age
Weight
Our laboratory does not accept specimens from patients who reside in or physicians who practice in the state of New York.
Person Responsible for Charges
(If different than above)
First Name
Last Name
Address
City
Country
State
Home Phone
Zip
Cell Phone
E-mail
Physician Information
(Signature required to process sample)
First Name
Last Name
Credentials
Institution Address
City
Country
State
Phone
Zip
Fax
E-mail
NPI
Physician Signature
REQUIRED
ICD-9 Codes (required for insurance)
Method of Payment & Insurance Information (select one) □ Bill Insurance (Non-Contracted) – Must enclose 20% down payment See price list attached for amount due and select payment type below. □ Bill Insurance (Contracted)
See Insurance Overview on page 3 to determine whether your insurance is considered contracted, non-contracted, or non-covered. Medicare/Medicare Advantage must fill out “Advance Beneficiary Notice of Noncoverage (ABN) form.”
□ Self Pay – Must enclose full payment (select payment method below) □ Check □ Money Order □ PayPal □ Visa □ MasterCard □ American Express □ Discover Amount: $_______________________ Credit Card #: _______________________________________ Exp. Date: ________ Security Code: _____
MUST FILL OUT TEST ORDERS ON REVERSE
Name on Card: ____________________________________ Signature: ______________________________ □ Bill Physician – Physician’s Name: __________________________________________________________
Primary Insurance
(include photocopy of insurance card (both sides)
Secondary Insurance (include photocopy of insurance card (both sides)
Company & Plan Name (ex. BCBS of Kansas City)
Company & Plan Name (ex. BCBS of Kansas City)
Insurance Company Address
Insurance Company Address
City
State
Zip
City
State
Insurance Company Phone (required)
Insurance Company Phone (required)
Name of Insured
Name of Insured
Date of Birth of Insured (MM/DD/YYYY)
Patient Relationship to Insured
Date of Birth of Insured (MM/DD/YYYY)
□ Self □ Spouse □ Child □ Other Subscriber #
Group #
Zip
Patient Relationship to Insured
□ Self □ Spouse □ Child □ Other Subscriber #
Group #
I authorize and request payment of medical benefits be made directly to The Great Plains Laboratory for the requested lab work on this Form. I authorize the release of any medical information necessary to process this claim. I understand that any reimbursement checks and explanation of benefits (EOBs) received by the patient must be submitted to The Great Plains Laboratory. I agree to be personally and fully responsible for any portion of the claim not covered by my insurance and agree to make such payment within 30 days. A service charge of 1.5% per month may be charged on balances over 30 days. I permit a copy of this to be used in place of the original. Patient/Guarantor Signature:
Date (MM/DD/YYYY):
Internal Use Only: O ____ A ____ DE ____ C ____ SR ____ Carevoyant # ______________ F ____ M ____ E ____ I ____ DR _________ Page 1 of 5
Revised 07/10/15
Date and time of collection REQUIRED to process specimens.
STOP
URINE:
Collection Date: __________ Time: ________ Has urine been frozen? □ Yes □ No
□ AM □ PM
STOOL 1: Collection Date: __________ Time: ________ □ AM □ PM STOOL 2: Collection Date: __________ Time: ________ □ AM □ PM
BLOOD: Collection Date: __________ Time: ________ □ AM □ PM
URINE
HAIR:
Collection Date: __________ Time: ________
□ AM □ PM
BLOOD, SERUM & HAIR
Amino Acids Test (43) Random Collection 24 Hr. Total vol. ____ mL Gluten / Casein Peptides Test GPL-TOX (Toxic Organic Chemical Profile) Kryptopyrrole Test Metals Urine Test (38) (select type of collection) Random Timed
# of hrs. _____________ Total vol. _________ mL
24 Hr. Total vol. __________ mL Pre or
Post Provoking agent __________ dosage ________
Microbial Organic Acids Test (MOAT) (21) (included in OAT) Organic Acids Test (OAT) (74) Phospholipase A2 Activity Test Porphyrins Profile Uric Acid Test Random Collection 24 Hr. Total vol. ____ mL Other _______________________________________________
STOOL Comprehensive Stool Analysis x 2 Metals Fecal Test (13) Pre or Post Provoking agent _____________ dosage___________ Does the patient have dental amalgams?
Yes
No; If so, how many? ____
Yeast Culture w/ Sensitivity Test Other _______________________________________________
COMBO TEST ORDERS * Microbial Organic Acids Test + Yeast Culture w/ Sensitivity Test Combo Organic Acids Test + Amino Acids Urine Test Combo Random Collection
24 Hr. Total vol. ____ mL
Amino Acids Plasma Test (43) (requires overnight fast) Advanced Cholesterol Profile C-Reactive Protein Test (hs-CRP) Celiac Disease Test (Transglutaminase) Ceruloplasmin Test Comprehensive Fatty Acids Test (requires overnight fast and frozen sample) Copper Test Copper / Zinc Profile DNA Methylation Pathway Profile IgE Allergy Advanced Combined Test (93 foods & 69 inhalants) IgE Food Allergy Essential Test (12) IgE Food Allergy Basic Test (25) IgE Food Allergy Advanced Test (93) IgE Inhalant Allergy Basic Test (36) IgE Inhalant Allergy Advanced Test (69) IgG Food Allergy Test w/ Candida - Dried Blood Spot (DBS) (94) IgG Food Allergy Test w/ Candida - Serum (94) IgG Asian Food Allergy Test w/ Candida - Dried Blood Spot (DBS) (94) IgG Asian Food Allergy Test w/ Candida - Serum (94) Immune Deficiency Profile Metals Test: Hair (39) Whole Blood (20) Red Blood Cell (18) Prealbumin Test Streptococcus Antibodies Profile Vitamin D Test - Dried Blood Spot (DBS) Vitamin D Test - Serum Zinc Test Other _______________________________________________
TEST PANEL ORDERS
Organic Acids Test + IgG Food Allergy Test w/ Candida – Dried
Comprehensive Autism Panel
Blood Spot (DBS) Combo
Basic Autism Panel Comprehensive AD(H)D Panel Basic AD(H)D Panel Comprehensive Tourette’s & Tics Panel
Organic Acids Test + IgG Food Allergy Test w/ Candida – Serum Combo Organic Acids Test + Yeast Culture w/ Sensitivity Test Combo GPL3: Organic Acids Test + Metals Hair + IgG Dried Blood Spot GPL4-DBS: Organic Acids Test + IgG Food Allergy Test w/ Candida + Metals Hair + Phospholipase A2 Activity Test GPL4-Serum: Organic Acids Test + IgG Food Allergy Test w/ Candida + Red Blood Cell + Phospholipase A2 Activity Test IgG Food Allergy Test w/ Candida + IgE Food Allergy Essential Test * Combo discounts only apply for kits that arrive in same FedEx Clinical Pak
Basic Tourette’s & Tics Panel Comprehensive Fibromyalgia & CFS Panel Basic Fibromyalgia & CFS Panel Comprehensive Wellness Panel Basic Wellness Panel Comprehensive Mental Health Panel Basic Mental Health Panel
NOTE: Individual tests included in these panels can be found on the Price List.
GPL is required by law to maintain the privacy of your Protected Health Information. The complete privacy policy can be found online at www.gpl4u.com/privacy
May we use your test data for research purposes without any identifying information being released? □Yes
□No
If yes, please fill the boxes below as applicable to this patient. □ ADD/ADHD □ Alzheimer’s □ Asperger’s
□ Autistic symptoms □ Chronic fatigue □ Colitis
□ Crohn’s disorder □ Depression □ Down syndrome
□ Fibromyalgia □ Irritable bowel □ Multiple sclerosis
□ OCD □ PDD □ Psychosis
□ Schizophrenia □ Tourette syndrome □ Tic Disorder
□ Other (please list): _______________________________________________________________________________________________________________
□ Check here if you do not wish to receive future mailings and research updates from the Great Plains Laboratory, Inc.
Name: _______________________________________________ Signature:____________________________________ Date: ______________ Page 2 of 5
Revised 07/10/15
Revised 7/10/15
Insurance Overview Provider Blue Cross Blue Shield (BCBS)
Contracted Plans BCBS of Illinois BCBS of Kansas City PPO BCBS of Minnesota BCBS of Vermont
BCBS of Illinois: Comprehensive Stool Analysis not covered* Capital Blue Cross, Highmark, and Blue Shield of California: IgG Food Allergy Test w/ Candida not covered*
Blue Cross of Idaho PPO
Federal Employee Program
Blue Shield of California* *Blue Shield Covered
Highmark Blue Shield of Pennsylvania
California and plans that begin with ID# “XEK” are Non-Contracted Plans, see guidelines below.
Keystone Health Plan West - Pennsylvania (HMO) Highmark West Virginia
Capital Blue Cross of Pennsylvania
Contracted Insurance Providers
Restrictions
Carefirst BCBS – includes Maryland, Washington DC, and parts of Northern Virginia
Tricare
Tricare Prime Tricare Standard Tricare for Life
Medicare
Medicare Medicare Advantage PPO
*These tests must be paid in full at the time of Service
Tests not covered: Microbial Organic Acids Test, Porphyrins Profile, Kryptopyrrole Test, Comprehensive Fatty Acids Test. Hormones Panels cannot be billed for Tricare South Medicare Advantage HMO For non-eligible tests, refer to the Advance Beneficiary Notice (ABN) included in the Test Requisition Form
Medicare/Medicare Advantage does not pay for tests for which the documentation, including the patient record, does not support that the tests were reasonable or necessary, and does not cover routine screening tests. It is the responsibility of the ordering physician to document and maintain the medical necessity of each test in the patient’s medical record. Requirements: Comprehensive Stool Analysis requires payment of $94.44 Signed ABN required (see Test Requisition Form)
Provider Non-contracted Blue Cross Blue Shield (BCBS) Anthem Blue Cross of California Blue Cross of Massachusetts HMO Cigna Harvard Pilgrim Tufts United Healthcare
Non-Contracted Plans
Non-Covered Tests
Eligibility All Non-Contracted plans will require a 20% down payment (see price list) Any restricted plans or tests must pay in full at the time of service
Restrictions Contracted Insurance Providers and Non-Covered Plans IgG Food Allergy Test not covered for: Anthem BCBS of California BCBS of North Carolina
The Great Plains Laboratory files the insurance claim on behalf of the patient. Some insurance companies provide payment and Explanation of Benefits (EOB) to the patients directly. If the patient is paid directly, the endorsed check and EOB must be forwarded to The Great Plains Laboratory (endorse back of check: “Pay to the order of The Great Plains Laboratory” and sign).
Amino Acids Plasma or Urine Test
DNA Methylation Pathway Profile
Kryptopyrrole Test
Phospholipase A2 Activity Test
GPL-TOX (Toxic Organic Chemical Profile)
We are not in-network with any of these plans and will not bill to these insurance carriers. Full cash price payment required and must be submitted with specimens. A receipt will be sent to the patient. HMO plans (except those listed Aetna UMR above) All non-eligible plans (see above) United Healthcare of the River Valley
Non-Covered Plans
BCBS of Florida BCBS of Iowa BCBS of Arizona BCBS of Texas
Humana
Wellmark BCBS of Iowa
Medicaid Silver Direct Access (a plan under Anthem Blue Cross of California)
Wellmark BCBS of South Dakota
GEHA
For any questions regarding insurance coverage, please call 913-341-8949 or 913-754-0459 Always call your insurance provider to confirm benefits as insurance coverage is subject to change. Patients are responsible for any deductibles, copayments, cost shares, coinsurance, or balance. If for any reason your insurance company deems your lab work as a noncovered or medically unnecessary service, you will be responsible for the full amount of the charge. We are currently applying for in-network coverage with several individual BCBS state programs. Please check our website for updated information at www.GPL4U.com/Insurance_Overview. Also available at this location is our insurance coverage verification guide to assist in determining coverage. NOTE: Insurance is filed in the state where the referring physicians NPI is registered, or where the referring physician's NPI is currently located. Page 3 of 5
Revised 07/10/15
(A) Notifier(s): (B) Patient Name:
(C) Identification Number:
ADVANCE BENEFICIARY NOTICE OF NONCOVERAGE (ABN) NOTE: If Medicare doesn’t pay for the tests in section (D) below, you may have to pay. Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the tests in section (D) below.
(D)
(E) Reason Medicare May Not Pay:
Comprehensive Fatty Acids Test Comprehensive Stool Analysis: Lysozyme, Short Chain Fatty Acids, Secretory IgA, Occult Blood
Medicare does not pay for experimental or research use tests.
$299.00
Medicare never pays for these tests.
$94.44
GPL-TOX (Toxic Organic Chemical Profile)
Medicare does not pay for experimental or research use tests. Medicare does not pay for experimental or research use tests. Medicare does not consider these tests to be medically necessary Medicare does not consider these tests to be medically necessary Medicare does not consider these tests to be medically necessary Medicare does not consider these tests to be medically necessary Medicare does not consider these tests to be medically necessary Medicare does not consider these tests to be medically necessary Medicare does not consider these tests to be medically necessary Medicare does not pay for experimental or research use tests. Medicare does not pay for experimental or research use tests. Medicare does not pay for experimental or research use tests. Medicare does not pay for experimental or research use tests. Medicare does not pay for experimental or research use tests. Medicare does not pay for experimental or research use tests. Medicare does not pay for experimental or research use tests. Medicare does pay for the Organic Acid Test, but does not pay for the combo. Medicare does not pay for this test for my condition.
$219.00 $119.00 $119.00 $379.00 $579.00 $379.00 $449.00 $325.00 $325.00 $129.00 $245.00 $245.00 $345.00 $299.00 $305.00 $99.00
Gluten/Casein Peptides Test IgE Food Allergy Essential Test IgE Food Allergy Basic Test IgE Food Allergy Advanced Test IgE Inhalant Allergy Basic Test IgE Inhalant Allergy Advanced Test IgG Food Allergy Test w/ Candida IgG Asian Food Allergy Test Kryptopyrrole Test Metals Fecal Test Metals Hair Test Metals Red Blood Cell Test Metals Urine Test Metals Whole Blood Test
Phospholipase A2 Activity Test OAT + IgG Food Allergy Test w/ Candida Combo Vitamin D Test
(F) Estimated Cost:
$699.00 $99.00
WHAT YOU NEED TO DO NOW:
Read this notice, so you can make an informed decision about your care. Ask us any questions that you may have after you finish reading. Choose an option below about whether to receive the tests listed above in section (D). Note: If you choose Option 1 or 2, we may help you to use any other insurance that you might have, but Medicare cannot require us to do this.
(G) OPTIONS: Check only one box. We cannot choose a box for you. ❏ OPTION 1. I want the tests listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN. If Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles. ❏ OPTION 2. I want the tests listed above, but do not bill Medicare. You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed. ❏ OPTION 3. I don’t want the tests listed above. I understand with this choice I am not responsible for payment, and I cannot appeal to see if Medicare would pay.
(H) Additional Information: This notice gives our opinion, not an official Medicare decision. If you have other questions on this notice or Medicare billing, call 1-800-MEDICARE (1-800-633-4227/TTY: 1-877-486-2048). Signing below means that you have received and understand this notice. You also receive a copy.
(I) Signature:
(J) Date:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0566. The time required to complete this information collection is estimated to average 7 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.
Form CMS-R-131 (03/08)
Page 5 of 5
Form Approved OMB No. 0938-0
Revised 07/10/15
Nutritional Supplements
Nutritional Supplements
7
Nutritional Supplements
ORDER
Distributor Prices
Product
PACKAGES Code
Description
Nutritional Support Starter Package (BNP, CLMG, CLOL, ANTX & ZNCP-180) Syndion Nutritional Support Starter Package (SYND-P, CLOL & CLMG) Yeast Control Package - Liquid (GLDN-L, UVA-L, BWAL, & ALL-L)
NSSP SNSP YCPL
ANTIOXIDANTS (cont)
Amt.
Retail Distrib. Qty. Price Price
1 pack
$133.00
$93.10
1 pack
$123.00
$86.10
1 pack
$85.00
$59.50
MULTI-VITAMINS BNP DRES ONE-30 SYND-C SYND-P SSM-U SSV
Basic Nutrients Plus Daily Resource One n’ Only™ Syndion™ Capsules NEW! Syndion™ Powder BrainChild S.S. II Minerals - Unflavored BrainChild S.S. II Vitamins - Lemon Lime
BCOM BIOT FOLN MFOL NIAC-100 NIAC-500 P5PM VB1 VB12-L VB6 VITA VITC VITC-C VITC-T VITD-L VITD VITE VITE-L VITK-60
B-Complex Biotin 1000 mcg Folinic Acid 400 mcg Methyl-Folate 1000 mcg Niacin, 100 mg Niacinamide 500 mg P-5-P with Magnesium Vitamin B1 Thiamine 100 mg Methyl-Mate - Liquid Methylcobalamin Vitamin B6, 50 mg Micellized Vitamin A 5025 IU Vitamin C Chewable 250 mg Buffered Vitamin C Vitamin C Powder from Tapioca Micellized Vitamin D 1000 IU Vitamin D 1000 IU Vitamin E 400 IU Aqua-E Vitamin E Vitamin K2 (Menatetrenone) 5 mg
CALC-180 CALI CAL-P CLMG CLMG-C CMTE CPRI IODC IRNI LITH LITH-60 MAGC-120 MAG-P MAGI MLBDI POTI SLNM SELL ZNCR ZNCI ZNCP ZNCP-180
Chelated Calcium Liquid Calcium - Ionic Calcium Citrate Powder Calcium Chewable w/Magnesium Cal/Mag Citrate Chelate-Mate - Ionic Liquid Copper - Ionic Iodine Complex, 6.25 Liquid Iron - Ionic Liquid Lithium - Ionic Lithium Orotate Chelated Magnesium 235 mg Magnesium Citrate Powder Liquid Magnesium - Ionic Liquid Molybdenum - Ionic Liquid Potassium - Ionic Chelated Selenium 250 mg Selenium Liquid 250 mcg Chelated Zinc 50 mg Liquid Zinc - Ionic Zinc Picolinate 50 mg Zinc Picolinate 25 mg
180 caps 240 caps 30 caps 180 caps 188 g 32 oz 32 oz
$26.00 $44.00 $15.00 $59.00 $69.00 $54.50 $54.50
$18.20 $30.80 $10.50 $41.30 $48.30 $54.50 $54.50
$19.00 $10.00 $13.00 $27.00 $6.00 $9.00 $22.00 $5.00 $35.00 $8.00 $18.00 $7.00 $22.00 $30.00 $21.00 $8.00 $22.00 $40.00 $21.00
$13.30 $7.00 $9.10 $18.90 $4.20 $6.30 $15.40 $3.50 $21.00 $5.60 $12.60 $4.90 $15.40 $21.00 $14.70 $5.60 $15.40 $28.70 $14.70
$29.00 $29.00 $18.00 $29.00 $22.00 $43.00 $20.00 $14.00 $20.00 $26.00 $21.00 $24.00 $27.00 $29.00 $20.00 $20.00 $12.00 $13.00 $14.00 $21.00 $13.00 $18.00
$20.30 $20.30 $12.60 $20.30 $15.40 $30.10 $14.00 $9.80 $14.00 $18.20 $14.70 $16.80 $18.90 $20.30 $14.00 $14.00 $8.40 $9.10 $9.80 $14.70 $9.10 $12.60
VITAMINS 90 caps 100 tabs 120 caps 120 caps 100 tabs 100 caps 100 caps 100 tabs 30 ml 100 tabs 1 fl. oz 100 tabs 180 caps 150 g 1 fl. oz 100 soft gels 100 soft gels 8 fl. oz 60 caps
MINERALS 180 caps 16 fl oz 300 g 250 tabs 250 caps 16 fl oz 50 ml 90 caps 50 ml 50 ml 60 caps 120 caps 300 g 16 fl oz 50 ml 50 ml 90 caps 2 fl oz 60 caps 50 ml 60 caps 180 caps
ANTIOXIDANTS ANTX COEQ GLUT LGSH-L
Antioxidant Formula Coenzyme Q-10 25 mg w/L-Taurine L-Glutathione 75 mg Essential GSH-Liposomal Glutathione
Mental Health Support =
7797 Quivira Road,
180 caps 60 caps 60 caps 4 fl oz
$35.00 $21.00 $20.00 $60.00
$24.50 $14.70 $14.00 $42.00
Total
Code
Description
Amt.
NAC NADH PYC-120 UBIQ
N-Acetyl Cysteine 500 mg NADH 5 mg Pycnogenol 25 mg Ubiquinol 100 mg
5HTP ALC CAR CARN GABA GLTM GLY LYS SAMe TAUR TYRO
5 HTP 50 mg Acetyl-L-Carnitine 500 mg L-Carnitine 250 mg L-Carnosine 500 mg GABA 500 mg L-Glutamine 500 mg Glycine 500 mg L-Lysine 500 mg SAMe 200 mg (Physician Referred) L-Taurine 500 mg Tyrosine 500 mg
BALP CLOC CLOC-L CLOL CLOL-NLM CLOL-S EPO UO3-120 VFFO-L
Balance Plus Carlson's Cod Liver Oil 1000 mg Carlson's Cod Liver Oil 1000 mg Carlson’s Cod Liver Oil (lemon flavored) Carlson’s Cod Liver Oil (unflavored) Nordic Naturals Cod Liver Oil (strawberry) Evening Primrose Oil Ultra Omega-3 Fish Oil Carlson's Very Finest Fish Oil
CLTR PROB-60 PROB SBC PBP THBC THBD THER VSL3-C
Culturelle 10 billion cells 30 caps Probiotic Support Formula 60 caps Probiotic Support Formula 30 caps Saccharomyces Boulardii 50 caps NEW! 15 packets Pro-Bio Premium Ther-Biotic™ Complete (Physician Referred) 60 caps Ther-Biotic™ Detox Support(Phys. Referred) 60caps Theralac 30 caps VSL#3 Capsules 60 caps
CNDX-120 DIZ-100 INT-120 INTP-120 NFEN
ZYME-CHEW
Candex DiZorb NEW! Interfase™ (Physician Referred) Interfase Plus™ (Physician Referred) Houston’s No-Fenol Houston’s No-Fenol Chewable Houston’s AFP Peptizyde Houston’s AFP Peptizyde Chewable Houston’s TriEnza Houston’s TriEnza Chewable Houston’s Zyme Prime Houston’s Zyme Prime Chewable
AIF-120 AIF-CHEW MLRN MIMM
A & I Formula A & I Formula Chewable Monolaurin 600 mg Transfer Fact. Multi-Immune (Phys. Ref.)
ALL-C ALL-L ARCH BWAL CDF CYF CURC
Allimax Allicin Capsules Allimax Liquid Artichoke Extract Black Walnut Extract Liquid Candida Defense Formula Candida Yeast Formula Curcumin 250
60 caps 60 tabs 120 caps 60 soft gels
Retail Distrib. Qty. Price Price
$22.00 $30.00 $38.00 $58.00
$15.40 $21.00 $26.60 $40.60
$20.00 $30.00 $17.00 $21.00 $15.00 $9.00 $12.00 $12.00 $48.00 $12.00 $16.00
$14.00 $21.00 $11.90 $14.70 $10.50 $6.30 $8.40 $8.40 $33.60 $8.40 $11.20
$21.00 $14.00 $20.00 $35.00 $35.00 $24.00 $19.00 $37.00 $35.00
$14.70 $9.80 $14.00 $24.50 $24.50 $16.80 $13.30 $25.90 $24.50
$22.00 $47.00 $26.00 $21.00 $52.00 $43.00 $52.00 $45.00 $48.00
$17.60 $32.90 $18.20 $14.70 $36.40 $30.10 $36.40 $31.50 $42.00
$49.00 $16.00 $48.00 $32.00 $25.00 $38.00 $25.00 $38.00 $48.00 $44.00 $24.00 $38.00
$34.30 $11.20 $33.60 $22.40 $17.50 $26.60 $17.50 $26.60 $33.60 $30.80 $16.80 $26.60
$34.00 $15.00 $33.00 $45.00
$23.80 $10.50 $23.10 $31.50
$33.00 $33.00 $13.00 $20.00 $29.00 $25.00 $24.00
$23.10 $23.10 $9.10 $14.00 $20.30 $17.50 $16.80
Total
AMINO ACIDS 100 caps 60 caps 60 caps 30 caps 60 caps 60 caps 100 caps 100 caps 60 tabs 100 caps 100 caps
ESSENTIAL FATTY ACIDS 90 soft gels 100 soft gels 250 soft gels 500 ml 500 ml 8 fl. oz 100 soft gels 120 soft gels 500 ml
PROBIOTICS
ENZYMES
NFEN-CHEW
PEPT-AFP
PEPT-CHEW
TRI-180 TRI-CHEW ZYME
120 caps 100 caps 120 caps 120 caps 90 caps 180 tabs 90 caps 180 tabs 180 caps 180 tabs 90 caps 180 tabs
IMMUNE SUPPORT 120 caps 60 tabs 90 caps 60 caps
BOTANICAL EXTRACTS NEW!
NEW!
Lenexa, KS 66215 Phone: (913) 754-0458 Fax: (913) 248-7609 Web: www.nbnus.com E-mail:
[email protected]
30 caps 10 ml 60 caps 1 fl oz 90 caps 2 oz 100 caps
Toll Free: 1-877-575-2467
Nutritional Supplements
ORDER
Distributor Prices
Product
BOTANICAL EXTRACTS (cont) Code
Description
Amt.
GLDN GLDN-L GSE-L MCT MILT OLXT ORGL PARA SMTO-L THEA UVA UVA-L
Goldenseal Extract 125 mg Goldenseal Extract Liquid Grapefruit Seed Extract Liquid M.C.T. Liquid Milk Thistle 200 mg Olive Leaf Extract 500 mg Oreganol P73 Parasite Formula Samento (Cat's Claw) L-Theanine 100 mg Uva Ursi 250 mg Uva Ursi Extract Liquid
AKG CHAR CHOL DMG ESC INOS MAL MELA-60 TMG TRUF
Alpha-Ketoglutaric Acid Activated Charcoal Sonic Cholesterol (Physician Referred) DMG-125 mg (Dimethylglysine) Epsom Salts Cream Inositol Powder Malic Acid 500 mg Melatonin 1 mg TMG Powder (Trimethylglycine) TruFiber™ Powder
Retail Distrib. Qty. Price Price
30 caps 1 fl. oz 2 fl. oz 8 fl. oz 60 caps 60 caps 60 soft gels 2 fl. oz 30 ml 60 caps 60 caps 1 fl. oz
$17.00 $20.00 $12.50 $14.00 $20.00 $17.00 $31.00 $25.00 $48.00 $19.00 $13.00 $20.00
$11.90 $14.00 $8.75 $9.80 $14.00 $11.90 $21.70 $17.50 $33.60 $13.30 $9.10 $14.00
$16.00 $10.00 $32.00 $26.00 $15.00 $34.00 $12.00 $7.00 $12.00 $33.00
$11.20 $7.00 $19.20 $18.20 $10.50 $23.80 $8.40 $4.90 $8.40 $23.10
SPECIALTY PRODUCTS 60 caps 90 caps 120 caps 100 tabs 2 oz 10 oz 100 caps 60 tabs 60 g 6.2 oz
DETOXIFICATION Bio-Chelat™
BIOC
100 ml 45 caps 120 caps 30 supp
DMSA-100 DMSA 100 mg (Physician Referred) DMSA-25 DMSA 25 mg (Physician Referred)
DTXM
Detoxamin 750 mg
COCO DARI DARI-C EGPZ KCSC PBPE RPP XGMP XGMS XYKT XYLI XYSM
Coconut Oil DariFree Potato Milk DariFree Chocolate Potato Milk Ener-G Foods Wylde Pretzels KinniTOOs Choc. Sand. Cremes Cookies Gorge Delights Pear Bar Rice Protein Plain Spry Peppermint Gum w/ Xylitol Spry Spearmint Gum w/ Xylitol Sugar Free Ketchup Smart Sweet XYLITOL Sugar Free Maple Syrup
$39.00 $27.30 $41.00 $28.70 $32.00 $22.40 $240.00 $168.00
FOOD / COOKING 32 oz Makes 6 qts Makes 5 qts 8 oz 8 oz 40 g 21 oz 10 pc. pack 10 pc. pack 10 oz 1.5 lbs 8.5 oz
$18.00 $12.00 $12.00 $4.00 $6.00 $1.75 $18.00 $1.25 $1.25 $6.00 $14.00 $6.00
$14.40 $10.60 $10.60 $3.20 $4.80 $1.40 $14.40 $1.00 $1.00 $4.80 $11.20 $4.80
PERSONAL CARE DEOC DEOL DEOU ECO REPL XNSL XTHP XTHP-BGUM
T. Naturals Deodorant Stick - Citrus Sport T. Naturals Deodorant Stick - Lavender T. Naturals Deodorant Stick - Unscented eco All-Natural Body Sunscreen All Natural Bug Repellent Spry Nasal Wash Spry Toothpaste Tube w/ Xylitol Branam Kids Bubblegum Toothpaste
55 g 55 g 55 g 3.5 oz 4 oz 1.5 oz 4 oz 5 oz
$6.00 $6.00 $6.00 $17.00 $12.00 $8.00 $5.50 $7.00
$4.80 $4.80 $4.80 $13.60 $9.60 $6.40 $4.40 $6.50 SUBTOTAL
TAX (8.9% for KS residents only) DISCOUNT (when applies) SHIPPING TOTAL
Total
Ordered by: First Name:
Middle Name:
Last Name:
Address:
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Ship to (if different): First Name:
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Notes:
Payment Method Amount To Be Charged: Money order
$ Check*
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*Make checks payable to New Beginnings Nutritionals. 7797 Quivira Rd., Lenexa, KS 66216
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Account # Name as it appears on card:
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Unopened products may be returned within 30 days of purchase. Shipping charge will not be refunded and all returned items are subject to a 10% restocking fee. Items cannot be returned after 30 days from the date of purchase. Probiotics may not be returned for any reason.
6/15/12
Quality Gluten/Casein Free Nutritional Supplements 7797 Quivira Road,
Lenexa, KS 66215 Phone: (913) 754-0458 Fax: (913) 248-7609 Web: www.nbnus.com E-mail:
[email protected]
Nutritional Supplements
Toll Free: 1-877-575-2467
Helping Children, Adults, and Families Make a Difference
Nutritional Supplements
New Beginnings Nutritionals 7797 Quivira Road, Lenexa, KS 66215 Phone: (913) 754-0458 Fax: (913) 248-7609
Toll Free: 1-877-575-2467
• • • • • • •
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Nutritional Supplements
New Beginnings Nutritionals
Introduction to Integrative Medicine for Mental Health
Introduction to Integrative Medicine for Mental Health
8
Introduction to Integrative Medicine for Mental Health
Introduction to Integrative Medicine for Mental Health The Integrative Medicine approach to treating mental health disorders utilizes multiple fields of medicine, nutritional sciences and biochemistry. This approach is supported by peer reviewed studies and successful clinical practice. Integrative Medicine for Mental Health (IMMH) seeks to improve the health and well-being of those affected with mental health disorders by recognizing that individual biochemistry plays a significant role in the way a patient responds to treatment. Traditional and specialized laboratory testing provide a roadmap to identify underlying causes and guide treatment to relieve symptoms. It is important to recognize that seemingly unrelated health issues can profoundly affect mental functioning. For example under-functioning thyroid, hormonal imbalances, nutritional deficiencies, food and environmental allergies, chemical sensitivities, infections, and exposure to environmental toxins all can influence mental health. Linus Pauling coined the term “Orthomolecular Medicine” as a treatment for disease and in particular, mental health. Traditional psychiatric and behavioral therapies can be greatly enhanced by understanding the body’s unique biochemistry and incorporating the right nutrients, in the proper amounts and form to support systemic functions. Molecules that support optimal mental functioning include vitamins, minerals, trace minerals, amino acids, essential fatty acids, enzymes and more. In previous generations, our foods contained much higher concentrations of nutrients than today’s food sources. Mega-farming, fast food, immune system dysfunction, exposure to infectious conditions and the daily exposure to thousands of environmental chemicals all contribute to imbalanced brain chemistry. Our cultural climate of fast-paced, high stress and sedentary lifestyles greatly influences the prevalence of mental health disorders. The zeebra formulations supplement line has been designed to meet the unique needs of individuals who suffer from a variety of mental health related disorders and is exclusively available through New Beginnings Nutritionals www.nbnus.com. The goal of this program is to advance the knowledge and improve the practice and treatment of mental health disorders by providing support to the mental health practitioner. IMMH offers a wealth of knowledge on research-based therapies through conferences, workshops, webinars, newsletters and other web-based resources. For updates, news and to contribute content please visit www.immh.org.
Website: www.immh.org E-mail:
[email protected]
Introduction to Integrative Medicine for Mental Health
Website: www.immh.org This website provides important information and resources for you and for patients seeking IMMH trained practitioners. The following is available on the website: Clinician Registry IMMH Clinician Manual Password protected for Great Plains Laboratory clients only. Contact your account representative for more information. Upcoming Conferences and Workshops Recorded Webinars Books and DVDs Scientific Research and Articles Newsletter Sign-Up Other Resources
Introduction to Integrative Medicine for Mental Health
Recommended Testing for Mental Health Patients Through The Great Plains Laboratory, Inc. Comprehensive Mental Health Panel Advanced Cholesterol Profile Amino Acids Urine Test Comprehensive Fatty Acids Test Comprehensive Stool Analysis Copper/Zinc Profile Gluten/Casein Peptides Test IgG Food Allergy Test w/ Candida Metals Hair Test Organic Acids Test Vitamin D Test
Basic Mental Health Panel Amino Acids Urine Test Comprehensive Fatty Acids Test Gluten/Casein Peptides Test IgG Food Allergy Test w/ Candida Metals Hair Test Organic Acids Test
Other GPL Testing Celiac Disease Test IgE Food & Inhalant Allergy Tests Metals Hair, Urine & Stool Tests Streptococcus Antibodies Profile Uric Acid Test Testing to Consider Through Traditional Labs* Complete Blood Count (CBC) Test Comprehensive Chemistry Panel Dehydroepiandrosterone-Sulfate (DHEA-S) Test Ferritin Test Thyroid Panel (TSH, T3, T4) *Unlike comprehensive biomedical testing, routine lab work often fails to uncover subtle abnormalities which can have a profound effect on health.
Introduction to Integrative Medicine for Mental Health
New Beginnings Nutritionals 7797 Quivira Road Lenexa, KS 66216 Phone: (913) 754-0458 Fax: (913) 248-7609 Toll Free: (877) 575-2467 E-mail:
[email protected]
What are zeebra formulations all about? Zeebra formulations is a new product line being distributed exclusively by New Beginnings Nutritionals. This product line is designed to meet the unique needs of individuals who suffer from a variety of mental health related disorders including depression, anxiety, bipolar, OCD, eating disorders, etc. These new products and formulations are made available under the careful direction of Dr. James Greenblatt, a child and adult psychiatrist who has been successfully treating patients with mental health disorders for over 20 years using an integrative medical approach
Who is Dr. James Greenblatt? James M. Greenblatt, M.D. is a dually board‐certified child and adult psychiatrist and is the Founder and Medical Director of Comprehensive Psychiatric Resources (CPR), an integrative psychiatry practice. Dr. Greenblatt received his medical degree and completed his adult psychiatry residency at George Washington University in Washington D.C., and completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. Dr. Greenblatt is an Assistant Clinical Professor at Tufts University Medical School, Department of Psychiatry. For over 20 years, Dr. Greenblatt has been a leader in Integrative Medicine, lecturing throughout North America on the scientific evidence for nutritional treatments in psychiatry and eating disorders. Dr. Greenblatt now serves as Medical Consultant for Mental Heath Disorders for New Beginnings Nutritionals. In his successful practice, Dr. Greenblatt incorporates specialized laboratory testing, dietary changes, nutritional supplements and other biomedical therapies with traditional treatments and therapies to improve the treatment outcomes of his patients.
What does the name “zeebra” mean? The word “zeebra” is mnemonic created from Dr. Greenblatt’s work on depression which emphasizes that every aspect of a person – mind, body and spirit – needs to be investigated. The most critical concept to understand is that just as the stripe pattern on every zebra is completely unique, each individual also has a completely unique biochemistry that needs to be explored through testing before effective treatments can be applied. With mental health disorders, just as in autism, a “one size fits all” approach is not effective.
Introduction to Integrative Medicine for Mental Health
What zeebra products are available now? Balance Plus (Omega 3, 6, and 9’s) Daily Resource (whole food based multivitamin) DiZorb (HCl and pepsin digestive enzyme) Iodine Complex (Iodine and Iodide) ZincSync (zinc sufficiency taste test)
Methyl‐Folate Niacin 100 mg Niacinamide 500 mg L‐Tyrosine 500 mg Lithium Orotate
Are these the only products helpful for mental health disorders? No. Many other products within the New Beginnings product line can be effectively used to support healthy mental functioning. Visit the Mental Health Support product category from the homepage of the New Beginnings Nutritionals website for comprehensive list of supporting products.
Are these products good for the autism population as well? With the exception of the Daily Resource Multivitamin, which contains copper, zeebra products can be used for individuals with autism because they contain the same purity and high standards that are found in the New Beginnings product line. It is recommended that you first seek the recommendation of your healthcare practitioner for appropriate product and dosage recommendations.
How do I learn more about integrative medicine for treating mental health disorders? Visit www.IMMH.org and sign up to receive a free e‐newsletter that will include vital information (upcoming conferences, free webinars, research, etc.) related to mental health issues.
Introduction to Integrative Medicine for Mental Health
New Beginnings Nutritionals
7797 Quivira Road, Lenexa, KS 66216 Contact us for product information, pricing and support Web: www.nbnus.com E-mail:
[email protected] Toll Free: 877-575-2467
Practitioner Supplement Recommendations Physician Information: Patient Date
Date:
__________________________ Name: __________________________ of Birth: __________ Weight: _________
Zeebra Formulations _____Daily Resource – 4 capsules, 2x daily with food _____ Methyl-Folate – 2 capsules daily with food _____ Niacin, 100 mg – 1-3 tablets daily _____ Niacinamide 500 mg – 1-4 capsules daily _____ Iodine Complex – 1 capsule daily with food _____ Lithium Orotate – 1 capsule daily with food _____ ZincSync – Read recommended use in catalog or at www.nbnus.com _____ Tyrosine – 1-4 capsules daily, between meals _____ Balance Plus – 3 capsules daily with food _____ DiZorb – 1-2 capsules after start of meal, do not take on empty stomach Related Products _____ Methyl-Mate/ Methylcobalamin – 5 drops daily, hold under tongue 1 min. before swallowing _____ Buffered Vitamin C – 2 or more capsules daily _____ Mycellized Vitamin D – 5 drops per day _____ Vitamin D 1000 IU – 2-5 soft gels daily with meals _____ Liquid Lithium- Ionic – Adults: 10 drops daily with food; Children: 3-5 drops daily with food _____ Chelated Magnesium – 1-2 capsules, 2x daily with or without food _____ Magnesium Citrate Powder – 1 scoop, 3x daily with meals _____ Liquid Magnesium- Ionic – 1.5 tsp in juice, 2x daily _____ Liquid Zinc – 10 drops daily with food, take separate from calcium _____ Zinc Picolinate 50 mg – 1 capsule daily, taken separate from calcium _____ Zinc Picolinate 25 mg – 1-2 capsules daily, taken separate from calcium _____ L-Glutathione – 1-2 caps daily _____ 5 HTP – 1-2 caps daily between meals _____ GABA – 1-4 capsule daily _____ L-Glutamine – 1-2 capsules daily _____ Glycine – 1-2 capsules daily with food _____ L-Taurine – 1-2 capsules daily _____ Evening Primrose Oil – 1 gelcap daily with food _____ Ultra Omega-3 Fish Oil – 1-2 gelcaps daily with food _____ Very Finest Fish Oil – 1-2 tsp daily with food _____ Houston’s AFP Peptizyde Capsules – 1-2 capsules before eating, not to exceed 9 daily _____ Houston’s TriEnza Capsules – 2 capsules with or just before each meal _____ Epsom Salts Cream – 1 or more grams to fatty areas, 2x daily _____ Inositol Powder – ¼ -1 tsp daily _____ Melatonin 1 mg – 2-4 tablets, 30 minutes prior to bedtime _____ Other _____________________________________________ _____ Other _____________________________________________
Introduction to Integrative Medicine for Mental Health
