Test utilization is an essential strategy in the clinical laboratory, especially with increasing numbers of tests and health care costs. We designed a triage system for molecular microbiology tests ordered from 2007 through 2010 to assess their appropriateness before they were sent out to a reference laboratory for testing. The number of tests ordered and approved and the number with positive results were calculated during the study period. Cost avoidance was subsequently calculated. A total of 13,839 tests were ordered, averaging 3,335 tests/year. The overall approval rate was 76%, ranging from 72% in 2007 to 81% in 2010. With the exception of cytomegalovirus (CMV) and BK virus PCR, the numbers of all tests decreased in 2010 compared to 2007. The total savings over 4 years was $374,791, with an average cost avoidance of $93,698/year. Pathologists and microbiologists should design a utilization system for laboratory testing to avoid unnecessary cost and improve patient care.