Test Catalog

Test Id : CMMPP

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Cobalamin, Methionine, and Methylmalonic Acid Pathways, Plasma

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Screening and monitoring patients suspected of or confirmed with an inherited disorder of methionine, cobalamin, or propionate metabolism using plasma specimens

 

Evaluating individuals with suspected deficiency of vitamin B12

Method Name
A short description of the method used to perform the test

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

CMMP, P

Aliases
Lists additional common names for a test, as an aid in searching

CBS deficiency

Cobalamin C deficiency

Cobalamin D deficiency

Cobalamin E deficiency

Cobalamin F deficiency

Cobalamin G deficiency

Cobalamin J deficiency

Cobalamin X deficiency

Hypermethioninemia

MAT I/III Deficiency

MAT Deficiency

Hypermethioninemia, isolated persistent

MMACHC

MMADHC

Combined Methylmalonic acidemia and homocystinuria

Homocysteine

Methylmalonic acid

Methylcitric acid

HCY

MMA

PA

Methylenetetrahydrofolate reductase (MTHFR) deficiency

Transcobalamin II deficiency:

Adenosylhomocysteinase (AHCY) deficiency

Glycine N-methyltransferase (GNMT) deficiency

Specimen Type
Describes the specimen type validated for testing

Plasma

Necessary Information

Patient's age and sex are required.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube:

Preferred: Lavender top (EDTA)

Acceptable: Green top (sodium or lithium heparin)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Immediately place specimen on ice.

2. Within 4 hours of collection, centrifuge and aliquot plasma into plastic vial. Note: If blood cannot be placed on wet ice immediately, centrifuge and aliquot plasma into a plastic vial within 1 hour of collection.

3. A refrigerated centrifuge is not required if the above time restrictions are met.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

0.4 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Plasma Refrigerated (preferred) 28 days
Ambient 28 days
Frozen 309 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Screening and monitoring patients suspected of or confirmed with an inherited disorder of methionine, cobalamin, or propionate metabolism using plasma specimens

 

Evaluating individuals with suspected deficiency of vitamin B12

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Homocysteine, methylmalonic acid (MMA), methylcitric acid, methionine, cysteine, and cystathionine can be used to evaluate patients for inborn errors of methionine, cobalamin, and propionate metabolism. Homocysteine is an intermediary in the sulfur-amino acid metabolism pathways, linking the methionine cycle to the folate cycle.

 

Inborn errors of metabolism that lead to homocysteinemia or homocystinuria include cystathionine beta-synthase deficiency (homocystinuria) and various defects of methionine remethylation.

 

Homocystinuria is an autosomal recessive disorder caused by a deficiency of the enzyme cystathionine beta-synthase. The incidence of homocystinuria is approximately 1 in 200,000 to 335,000 live births. Classical homocystinuria is characterized by a normal presentation at birth followed by failure to thrive and developmental delay. Untreated homocystinuria can lead to ophthalmological problems, developmental delay, seizures, thromboembolic episodes, and skeletal abnormalities. The biochemical phenotype is characterized by increased plasma concentrations of methionine and homocysteine along with decreased concentrations of cystine.

 

Elevated levels of MMA result from inherited defects of enzymes involved in MMA metabolism or inherited or acquired deficiencies of vitamin B12.

 

Enzymatic deficiencies of propionyl-CoA carboxylase and methylmalonyl-CoA mutase are associated with propionic academia (PA) and methylmalonic acidemia mut(0/-) type (MMAmut), respectively. The clinical phenotype includes vomiting, hypotonia, lethargy, apnea, hypothermia, and coma. The biochemical phenotype for MMAmut includes elevations of propionyl carnitine, methylmalonic acid, and methylcitric acid. Patients with PA will have elevations of propionyl carnitine and methylcitric acid with normal MMA concentrations as the enzymatic defect is upstream of methylmalonic-CoA mutase.

 

Inherited conditions of cobalamin (Cbl) absorption and transport are caused by variants in several genes encoding Cbl binding factors and transmembrane transporters and receptors. In addition, inside the cell, Cbl undergoes several steps of modification until it reaches a divergent point beyond which 2 separate paths lead to the formation of the 2 active components of this cofactor: adenosylcobalamin (AdoCbl), a cofactor for methylmalonyl-CoA mutase; and methylcobalamin (MeCbl), a cofactor for methionine synthase, remethylating homocysteine to methionine.

 

Defects of AdoCbl and MeCbl metabolism after the point where the synthetic pathways separate lead to isolated deficiencies of methylmalonyl-CoA mutase (elevations of propionyl carnitine, MMA, and methylcitric acid) or methionine synthase (elevated homocysteine with low/low normal methionine) respectively. Defects prior to this point are associated with deficiencies of both enzymes and lead to elevation of all markers (propionyl carnitine, MMA, methylcitric acid, and homocysteine).

 

Acquired cobalamin (vitamin B12) deficiency can be a result of pernicious anemia, vegan diet, malabsorption, and decreased intrinsic factor excretion (secondary to gastrectomy) and can be distinguished from most inherited defects (particularly intracellular deficiencies) with the identification of decreased levels of vitamin B12. Older adult patients with acquired cobalamin deficiency may present with megaloblastic anemia, peripheral neuropathy, ataxia, loss of position and vibration senses, memory impairment, depression, and dementia in the absence of anemia. Other conditions such as kidney insufficiency, hypovolemia, and bacterial overgrowth of the small intestine also contribute to the possible causes of mild methylmalonic acidemia and aciduria. Additional testing with homocysteine and MMA determinations may help distinguish between vitamin B12 and folate deficiency states.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Age

Total homocysteine
(nmol/mL)

Methylmalonic acid (nmol/mL)

2-Methylcitric
acid (nmol/mL)

Total cysteine
(nmol/mL)

Methionine (nmol/mL)

Cystathionine
(nmol/mL)

Female

Male

Female

Male

0-11 months

3.1-8.3

3.2-9.7

0.08-0.32

0.02-0.35

142.8-258.8

14.7-43.1

14.5-42.3

0.07-0.38

12-23 months

3.2-8.3

3.3-9.6

0.08-0.31

0.02-0.35

143.7-258.7

14.7-43.1

14.5-42.2

0.07-0.38

24-35 months

3.2-8.2

3.3-9.6

0.08-0.31

0.02-0.35

144.8-258.6

14.7-43.0

14.5-42.1

0.07-0.38

3 years

3.2-8.2

3.3-9.6

0.08-0.31

0.02-0.35

146.0-258.5

14.7-43.0

14.5-42.0

0.07-0.38

4 years

3.3-8.2

3.4-9.5

0.08-0.30

0.02-0.35

148.2-258.4

14.7-42.8

14.5-41.8

0.07-0.38

5 years

3.4-8.1

3.5-9.4

0.08-0.30

0.02-0.35

150.6-258.3

14.8-42.7

14.5-41.6

0.07-0.38

6 years

3.5-8.1

3.6-9.4

0.08-0.29

0.02-0.35

153.2-258.3

14.8-42.5

14.5-41.4

0.07-0.38

7 years

3.5-8.1

3.7-9.4

0.08-0.29

0.02-0.35

155.8-258.4

14.8-42.2

14.5-41.1

0.07-0.38

8 years

3.6-8.2

3.8-9.3

0.08-0.28

0.02-0.35

158.5-258.7

14.9-42.0

14.6-40.9

0.07-0.37

9 years

3.7-8.2

3.9-9.4

0.09-0.28

0.02-0.35

161.0-259.1

14.9-41.7

14.6-40.7

0.07-0.37

10 years

3.8-8.3

4.1-9.4

0.09-0.28

0.02-0.35

163.5-259.7

15.0-41.4

14.7-40.6

0.07-0.37

11 years

3.9-8.4

4.3-9.4

0.09-0.28

0.02-0.35

165.9-260.5

15.1-41.0

14.8-40.4

0.07-0.37

12 years

3.9-8.6

4.4-9.5

0.09-0.27

0.02-0.35

168.4-261.4

15.1-40.7

14.9-40.3

0.07-0.37

13 years

4.0-8.7

4.6-9.6

0.09-0.27

0.02-0.35

170.9-262.4

15.2-40.3

15.1-40.1

0.07-0.36

14 years

4.1-8.8

4.8-9.7

0.09-0.27

0.02-0.35

173.6-263.6

15.3-39.9

15.3-40.0

0.07-0.36

15 years

4.2-8.9

5.0-9.8

0.09-0.27

0.02-0.35

176.4-264.7

15.4-39.5

15.5-39.9

0.07-0.36

16 years

4.2-9.1

5.2-9.9

0.09-0.27

0.02-0.35

179.3-265.9

15.5-39.1

15.8-39.7

0.07-0.35

17 years

4.3-9.2

5.4-10.0

0.09-0.27

0.02-0.35

182.2-267.1

15.6-38.7

16.1-39.6

0.07-0.35

18 years

4.3-9.3

5.6-10.1

0.08-0.27

0.02-0.35

184.9-268.3

15.7-38.2

16.4-39.4

0.07-0.35

19 years

4.4-9.5

5.7-10.3

0.08-0.26

0.02-0.35

187.4-269.4

15.7-37.8

16.7-39.3

0.07-0.34

20 years

4.4-9.6

5.9-10.5

0.08-0.26

0.02-0.35

189.5-270.5

15.8-37.3

17.0-39.1

0.07-0.34

21 years

4.4-9.8

6.0-10.6

0.08-0.26

0.02-0.35

191.2-271.7

15.9-36.8

17.3-38.9

0.07-0.33

22 years

4.4-9.9

6.1-10.8

0.08-0.27

0.02-0.35

192.5-272.8

15.9-36.3

17.6-38.7

0.07-0.33

23 years

4.4-10.1

6.2-11.0

0.08-0.27

0.02-0.35

193.5-274.1

15.9-35.8

17.9-38.5

0.07-0.33

24 years

4.4-10.3

6.2-11.1

0.08-0.27

0.02-0.35

194.2-275.4

15.9-35.3

18.1-38.3

0.07-0.32

25 years

4.4-10.4

6.3-11.3

0.08-0.28

0.02-0.35

194.8-277.0

15.9-34.8

18.2-38.1

0.07-0.32

26 years

4.4-10.6

6.3-11.4

0.08-0.28

0.02-0.35

195.3-278.6

15.9-34.3

18.4-37.9

0.07-0.32

27 years

4.3-10.8

6.4-11.6

0.08-0.28

0.02-0.35

196.0-280.5

16.0-33.8

18.5-37.7

0.07-0.31

28 years

4.3-11.0

6.4-11.7

0.08-0.29

0.02-0.35

196.7-282.4

16.0-33.4

18.7-37.5

0.07-0.31

29 years

4.3-11.2

6.4-11.8

0.08-0.29

0.02-0.35

197.7-284.3

16.0-33.0

18.8-37.3

0.07-0.31

30 years

4.3-11.4

6.4-11.9

0.08-0.30

0.02-0.35

198.8-286.3

16.1- 32.6

18.9-37.1

0.07-0.30

31 years

4.4-11.6

6.4-12.1

0.08-0.30

0.02-0.35

200.2-288.2

16.1-32.2

19.0-36.9

0.07-0.30

32 years

4.4-11.8

6.4-12.2

0.08-0.31

0.02-0.35

201.7-290.0

16.1-31.8

19.1-36.7

0.07-0.30

33 years

4.4-11.9

6.4-12.3

0.08-0.31

0.02-0.35

203.4-291.5

16.1-31.5

19.2-36.5

0.07-0.29

34 years

4.5-12.1

6.4-12.4

0.08-0.31

0.02-0.35

205.2-292.9

16.1-31.2

19.3-36.3

0.07-0.29

35 years

4.5-12.2

6.4-12.6

0.08-0.32

0.02-0.35

207.2-294.1

16.1-30.8

19.4-36.1

0.07-0.28

36 years

4.6-12.4

6.4-12.8

0.08-0.32

0.02-0.35

209.3-295.1

16.1-30.5

19.5-35.9

0.07-0.28

37 years

4.6-12.5

6.4-12.9

0.08-0.33

0.02-0.35

211.5-296.0

16.1-30.2

19.6-35.6

0.07-0.27

38 years

4.7-12.7

6.4-13.1

0.08-0.33

0.02-0.35

213.8-296.9

16.1-29.9

19.7-35.4

0.07-0.27

39 years

4.7-12.8

6.4-13.2

0.08-0.34

0.02-0.35

216.3-297.7

16.1-29.7

19.8-35.2

0.07-0.27

40 years

4.8-13.0

6.5-13.4

0.08-0.34

0.02-0.35

218.9-298.7

16.1-29.4

19.9-35.0

0.07-0.27

41 years

4.8-13.2

6.5-13.5

0.08-0.35

0.02-0.35

221.6-299.7

16.1-29.2

20.0-34.8

0.07-0.27

42 years

4.8-13.4

6.5-13.7

0.08-0.36

0.02-0.35

224.3-300.8

16.2-29.0

20.1-34.6

0.07-0.26

43 years

4.9-13.5

6.6-13.9

0.08-0.36

0.02-0.35

227.0-302.0

16.2-28.8

20.2-34.4

0.07-0.26

44 years

4.9-13.7

6.6-14.0

0.08-0.37

0.02-0.35

229.8-303.5

16.3-28.6

20.3-34.2

0.07-0.26

45 years

4.9-13.9

6.6-14.2

0.08-0.38

0.02-0.35

232.6-305.2

16.3-28.5

20.3-34.0

0.07-0.26

46 years

4.9-14.0

6.7-14.4

0.08-0.38

0.02-0.35

235.3-307.3

16.4-28.4

20.4-33.8

0.07-0.26

47 years

4.9-14.2

6.7-14.5

0.08-0.39

0.02-0.35

238.0-309.7

16.4-28.2

20.4-33.6

0.07-0.26

48 years

5.0-14.3

6.8-14.7

0.08-0.39

0.02-0.35

240.8-312.6

16.5-28.1

20.5-33.3

0.07-0.26

49 years

5.0-14.4

6.8-14.9

0.08-0.40

0.02-0.35

243.5-315.9

16.5-28.0

20.5-33.1

0.07-0.26

50 years

5.0-14.5

6.8-15.0

0.08-0.40

0.02-0.35

246.2-319.7

16.5-27.9

20.6-32.8

0.07-0.26

51 years

5.1-14.6

6.8-15.2

0.08-0.41

0.02-0.35

248.9-323.8

16.5-27.8

20.6-32.5

0.07-0.26

52 years

5.1-14.7

6.9-15.4

0.08-0.41

0.02-0.35

251.5-328.1

16.5-27.6

20.7-32.3

0.07-0.26

53 years

5.1-14.8

6.9-15.5

0.08-0.42

0.02-0.35

254.0-332.4

16.5-27.5

20.8-32.1

0.07-0.26

54 years

5.2-14.9

6.9-15.6

0.08-0.42

0.02-0.35

256.4-336.5

16.5-27.4

21.0-31.9

0.07-0.25

55 years

5.2-15.0

6.9-15.7

0.08-0.43

0.02-0.35

258.6-340.2

16.5-27.3

21.1-31.7

0.07-0.25

56 years

5.3-15.0

6.9-15.8

0.08-0.43

0.02-0.35

260.6-343.6

16.6-27.2

21.2-31.5

0.07-0.25

57 years

5.3-15.1

6.9-15.9

0.08-0.44

0.02-0.35

262.5-346.5

16.6-27.1

21.2-31.3

0.07-0.25

58 years

5.3-15.2

6.9-16.0

0.08-0.44

0.02-0.35

264.3-349.0

16.6-27.1

21.3-31.0

0.07-0.25

59 years

5.4-15.2

6.9-16.0

0.08-0.44

0.02-0.35

266.2-351.1

16.7-27.1

21.3-30.8

0.07-0.25

60 years

5.4-15.3

6.9-16.1

0.08-0.45

0.02-0.35

268.3-353.1

16.8-27.1

21.3-30.6

0.07-0.25

61 years

5.4-15.4

7.0-16.2

0.09-0.45

0.02-0.35

270.8-355.1

16.9-27.2

21.3-30.3

0.07-0.25

62 years

5.5-15.4

7.0-16.2

0.09-0.46

0.02-0.35

273.8-357.3

17.0-27.2

21.2-30.0

0.08-0.25

63 years

5.5-15.5

7.0-16.3

0.09-0.46

0.02-0.35

277.5-359.7

17.1-27.3

21.2-29.8

0.08-0.25

64 years

5.6-15.5

7.1-16.3

0.09-0.46

0.02-0.35

281.9-362.3

17.2-27.4

21.1-29.5

0.08-0.25

65 years

5.6-15.6

7.1-16.3

0.09-0.47

0.02-0.35

286.9-365.2

17.3-27.6

21.1-29.2

0.08-0.25

66 years

5.7-15.6

7.1-16.3

0.09-0.47

0.02-0.35

292.4-368.3

17.4-27.7

21.1-29.0

0.08-0.25

67 years

5.7-15.7

7.2-16.3

0.09-0.47

0.02-0.35

298.1-371.6

17.5-27.8

21.0-28.7

0.09-0.25

68 years

5.8-15.7

7.2-16.3

0.09-0.47

0.02-0.35

303.6-374.8

17.7-27.9

21.0-28.5

0.09-0.25

69 years

5.9-15.7

7.2-16.3

0.09-0.47

0.02-0.35

308.7-377.8

17.8-28.0

21.0-28.4

0.09-0.25

70 years

6.0-15.8

7.3-16.3

0.09-0.48

0.02-0.35

313.1-380.7

18.0-28.1

21.0-28.3

0.09-0.25

71 years

6.1-15.8

7.3-16.3

0.09-0.48

0.02-0.35

316.5-383.2

18.1-28.2

20.9-28.2

0.09-0.25

72 years

6.2-15.8

7.3-16.3

0.09-0.48

0.02-0.35

318.9-385.3

18.3-28.3

20.9-28.0

0.09-0.25

73 years

6.3-15.9

7.3-16.3

0.09-0.48

0.02-0.35

320.1-387.0

18.5-28.4

20.8-27.9

0.10-0.26

74 years

6.4-15.9

7.3-16.3

0.09-0.48

0.02-0.35

320.6-388.3

18.8-28.5

20.8-27.8

0.10-0.26

75 years

6.5-15.9

7.3-16.3

0.09-0.48

0.02-0.35

320.3-389.3

19.1-28.5

20.8-27.7

0.10-0.26

76 years

6.6-15.9

7.3-16.3

0.09-0.48

0.02-0.35

319.6-389.9

19.3-28.6

20.8-27.5

0.10-0.26

77 years

6.7-16.0

7.4-16.3

0.10-0.48

0.02-0.35

319.1-390.2

19.6-28.6

20.9-27.4

0.10-0.26

78 years

6.8-16.0

7.4-16.3

0.10-0.48

0.02-0.35

318.5-390.5

20.0-28.7

20.9-27.2

0.11-0.26

79 years

6.9-16.0

7.5-16.3

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

80 years

7.0-16.0

7.5-16.3

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

81 years

7.1-16.0

7.7-16.2

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

82 years

7.2-16.0

7.8-16.2

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

83 years

7.2-16.0

7.9-16.2

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

84 years

7.3-16.0

8.0-16.2

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

85 years

7.3-16.0

8.2-16.2

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

>85 years

7.4-16.0

8.3-16.2

0.10-0.48

0.02-0.35

317.9-390.6

20.3-28.7

21.0-27.1

0.11-0.26

 

 

Interpretation
Provides information to assist in interpretation of the test results

An interpretive report will be provided.

 

When abnormal results are detected, a detailed interpretation is given, including an overview of the results and of their significance, a correlation to available clinical information, elements of differential diagnosis, recommendations for additional biochemical testing, and in vitro confirmatory studies (complementation studies, molecular analysis), and a phone number to reach one of the laboratory directors in case the referring physician has additional questions.

 

Abnormal results are not sufficient to conclusively establish a diagnosis of a particular disease. To verify a preliminary diagnosis based on the analysis, independent biochemical (eg, complementation studies) or molecular genetic analyses are required.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Normal levels may be seen in patients undergoing treatment.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Turgeon CT, Magera MJ, Cuthbert CD, et al. Determination of total homocysteine, methylmalonic acid, and 2-methylcitric acid in dried blood spots by tandem mass spectrometry. Clin Chem. 2010;56(11):1686-1695

2. Tortorelli S, Turgeon CT, Lim JS, et al. Two-tier approach to the newborn screening of methylenetetrahydrofolate reductase deficiency and other remethylation disorders with tandem mass spectrometry. J Pediatr. 2010;157(2):271-275

3. Huemer M, Diodato D, Schwahn B, et al. Guidelines for diagnosis and management of the cobalamin-related remethylation disorders cblC, cblD, cblE, cblF, cblG, cblJ and MTHFR deficiency. J Inherit Metab Dis. 2017;40(1):21-48

4. Baric I, Staufner C, Augoustides-Savvopoulou P, Chien YH, Dobbelaere D, Grunert SC. Consensus recommendations for the diagnosis, treatment and follow-up of inherited methylation disorders. J Inherit Metab Dis. 2017;40(1):5-20

5. Morris AA, Kozich V, Santra S, et al. Guidelines for the diagnosis and management of cystathionine beta-synthase deficiency. J Inherit Metab Dis. 2017;40(1):49-74

6. Sloan JS, Carrillo N, Adams D, Venditti CP. Disorders of intracellular cobalamin metabolism. In: Adam MP, Feldman J, Mirzaa GM, et al, eds. GeneReviews [Internet]. University of Washington, Seattle; 2008. Updated December 16, 2021. Accessed November 29, 2024. Available at www.ncbi.nlm.nih.gov/books/NBK1328/

7. Langan RC, Goodbred AJ. Vitamin B12 deficiency: Recognition and management. Am Fam Physician. 2017;96(6):384-389

Method Description
Describes how the test is performed and provides a method-specific reference

Total homocysteine, total cysteine, 2-methylcitric acid, methionine, cystathionine and methylmalonic acid are measured by stabile isotope dilution microflow liquid chromatography tandem mass spectrometry.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday, Wednesday, Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 6 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

1 week

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Mayo Clinic Laboratories - Rochester Main Campus
CLIA Number: 24D0404292

Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

83090

83918

82136

82542 (if appropriate for government payers)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
CMMPP CMMP, P 104535-0
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
606110 Interpretation 59462-2
606104 Total Homocysteine 13965-9
606105 Methylmalonic acid 13964-2
606119 2-Methylcitric acid 26904-3
606106 Methionine 20651-6
606107 Total Cysteine 20641-7
606108 Cystathionine 26607-2
606109 Reviewed By 18771-6

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
Test Changes - Specimen Information 2025-08-19