#### § 493.931 Routine chemistry.

(a) *Program content and frequency of challenge.* To be approved for proficiency testing for routine chemistry, a program must provide a minimum of five samples per testing event. There must be at least three testing events at approximately equal intervals per year. The annual program must provide samples that cover the clinically relevant range of values that would be expected in patient specimens. The specimens may be provided through mailed shipments.

(b) *Challenges per testing event.* The minimum number of challenges per testing event a program must provide for each analyte or test procedure listed below is five serum, plasma or blood samples.

| Alanine aminotransferase (ALT/SGPT). |
| --- |
| Albumin. |
| Alkaline phosphatase. |
| Amylase. |
| Aspartate aminotransferase (AST/SGOT). |
| Bilirubin, total. |
| Blood gas (pH, pO2, and pCO2). |
| B-natriuretic peptide (BNP). |
| proBNP. |
| Calcium, total. |
| Carbon dioxide. |
| Chloride. |
| Cholesterol, total. |
| Cholesterol, high density lipoprotein. |
| Cholesterol, low density lipoprotein, (direct measurement). |
| Creatine kinase (CK). |
| CK-MB isoenzymes. |
| Creatinine. |
| Ferritin. |
| Gamma glutamyl transferase. |
| Glucose (Excluding measurements on devices cleared by FDA for home use). |
| Hemoglobin A1c. |
| Iron, total. |
| Lactate dehydrogenase (LDH). |
| Magnesium. |
| Phosphorus. |
| Potassium. |
| Prostate specific antigen (PSA), total. |
| Sodium. |
| Total iron binding capacity (TIBC) (direct measurement). |
| Total Protein. |
| Triglycerides. |
| Troponin I. |
| Troponin T. |
| Urea Nitrogen. |
| Uric Acid. |

Table 1 to Paragraph (b)—Analyte or Test Procedure

(c) *Evaluation of a laboratory's analyte or test performance.* HHS approves only those programs that assess the accuracy of a laboratory's responses in accordance with paragraphs (c)(1) through (5) of this section.

(1) To determine the accuracy of a laboratory's response for qualitative and quantitative chemistry tests or analytes, the program must compare the laboratory's response for each analyte with the response that reflects agreement of either 80 percent or more of 10 or more referee laboratories or 80 percent or more of all participating laboratories. Both methods must be attempted before the program can choose to not grade a PT sample.

(2) For quantitative chemistry tests or analytes, the program must determine the correct response for each analyte by the distance of the response from the target value. After the target value has been established for each response, the appropriateness of the response must be determined by using either fixed criteria based on the percentage difference from the target value or the number of standard deviations (SD) the response differs from the target value.

| The criteria for acceptable performance are—
Analyte or test | Criteria for acceptable performance |
| --- | --- |
| Alanine aminotransferase (ALT/SGPT) | Target value ±15% or ±6 U/L (greater). |
| Albumin | Target value ±8%. |
| Alkaline phosphatase | Target value ±20%. |
| Amylase | Target value ±20%. |
| Aspartate aminotransferase (AST/SGOT) | Target value ±15% or ±6 U/L (greater). |
| Bilirubin, total | Target value ±20% or ±0.4 mg/dL (greater). |
| Blood gas pCO2 | Target value ±8% or ±5 mm Hg (greater). |
| Blood gas pO2 | Target value ±15% or ±15 mmHg (greater). |
| Blood gas pH | Target value ±0.04. |
| B-natriuretic peptide (BNP) | Target value ±30%. |
| Pro B-natriuretic peptide (proBNP) | Target value ±30%. |
| Calcium, total | Target value ±1.0 mg/dL. |
| Carbon dioxide | Target value ±20%. |
| Chloride | Target value ±5%. |
| Cholesterol, total | Target value ±10%. |
| Cholesterol, high density lipoprotein (HDL) | Target value ±20% or ±6 mg/dL (greater). |
| Cholesterol, low density lipoprotein (LDL), direct measurement | Target value ±20%. |
| Creatine kinase (CK) | Target value ±20%. |
| CK-MB isoenzymes | Target value ± 25% or ±3 ng/mL (greater) or MB elevated (presence or absence). |
| Creatinine | Target value ±10% or ±0.2 mg/dL (greater). |
| Ferritin | Target value ±20%. |
| Gamma glutamyl transferase | Target value ±15% or ±5 U/L (greater). |
| Glucose (excluding measurements devices cleared by FDA for home use.) | Target value ±8% or ±6 mg/dL (greater). |
| Hemoglobin A1c | Target value ±8%. |
| Iron, total | Target value ±15%. |
| Lactate dehydrogenase (LDH) | Target value ±15%. |
| Magnesium | Target value ±15%. |
| Phosphorus | Target value ± 10% or ±0.3 mg/dL (greater). |
| Potassium | Target value ±0.3 mmol/L. |
| Prostate Specific Antigen, total | Target value ±20% or ±0.2 ng/mL (greater). |
| Sodium | Target value ±4 mmol/L. |
| Total Iron Binding Capacity (TIBC). (direct measurement) | Target value ±20%. |
| Total Protein | Target value ±8%. |
| Triglycerides | Target value ±15%. |
| Troponin I | Target value ± 30% or ±0.9 ng/mL (greater). |
| Troponin T | Target value ±30% or ±0.2 ng/mL (greater). |
| Urea nitrogen | Target value ±9% or ±2 mg/dL (greater). |
| Uric acid | Target value ±10%. |

Table 2 to Paragraph (c)(2)—Criteria for Acceptable Performance

(3) The criterion for acceptable performance for qualitative routine chemistry tests is positive or negative.

(4) To determine the analyte testing event score, the number of acceptable analyte responses must be averaged using the following formula:

(5) To determine the overall testing event score, the number of correct responses for all analytes must be averaged using the following formula:

[57 FR 7151, Feb. 28, 1992, as amended at 68 FR 3702, Jan. 24, 2003; 87 FR 41238, July 11, 2022]