The cost of each test, along with applicable CPT billing codes, may be found by scrolling to the bottom of each test description (under “See All Tests”) The NCGL can bill the laboratory submitting the specimen or the patient’s insurance (including Medicaid). Alternately, the patient may provide payment at the time the sample is submitted.
To BILL INSTITUTION
The NCGL will bill the referring institution for the entire cost of the test ordered. Invoices are generated upon completion of testing. Payment terms are Net 30 from the date of invoice. Payment may be made by an institution check, money order or by Visa or MasterCard credit cards as instructed on the invoice from University of Washington Physicians (UWP).
To BILL PATIENT INSURANCE
When requesting billing of patient’s insurance, all information in the “Insurance Billing” section of the NCGL EXOME PANEL TESTING REQUISITION FORM or NCGL GENOME EXOME TESTING REQUISITION FORM must be completed. A clear copy of both the front and back of the patient’s insurance card must be submitted with the Requisition Form and specimen. It is required that pre-authorization be obtained from the insurance company before testing is initiated (either by the Provider or the CPDx, see below). If the Provider obtains pre-authorization the CPDx will not also confirm coverage or denial.
Pre-authorization for Genetic Testing:
As a courtesy to patients, the CPDx offers help with obtaining insurance pre-authorization for laboratory tests priced over $500. Our protocol is that we will not pre-authorize unless we have a sample in the lab. We have had to request this because we found after pre-auth was obtained some physicians used the approval elsewhere or never submitted a sample. We will hold DNA at no cost until the pre-auth is approved or denied.
Steps to take to request preauthorization can be found on the pre-authorization information sheet. Please note, Medicare does not preauthorize.
The following forms must accompany a submitted sample when requesting preauthorization:
Resources for the provider when submitting written support for genetic testing requests:
If genetic testing through the NCGL is denied, the physician may need to submit an appeal letter on behalf of the patient.
To BILL MEDICAID
For Medicaid Billing, please include:
- Preauthorization letter from Medicaid, with the effective dates of coverage (see Instructions for Medicaid billing)
- Medicaid claims address
- Copy of Card
- Letter of necessity from referring physician
You may want to consult NCGL MEDICAID FAQs to learn about steps for billing Medicaid.
To BILL MEDICARE
For Medicare Billing, please include:
- Copy of Card
- Completed MEDICARE ABN FORM (required as genetic testing may not be a covered service)
To BILL PATIENT
Patients must pay for tests using a credit card, money order or personal check submitted with the specimen and the Requsition Form. For international orders, all payments must be in U.S. dollars.
Pre-payment for international samples is required. Wire transfer payment instructions are available.
For Canadian samples: Please note that providers must acquire approval of all tests, including any possible reflex testing, before submitting samples.
SAMPLES on HOLD
We understand that obtaining proper billing documentation prior to sending samples may be difficult; as such, we are happy to hold samples until billing matters are resolved. Testing will be initiated once we are notified that tests will be covered and/or patients will assume responsibility of cost.
In the event a patient is not able to afford testing (or insurance is billed and denies coverage) the NCGL offers several options through University of Washington Physicians (UWP), including a monthly payment plan, full pay discounts, and charity care options. Please contact the UWP at 206-543-8606 or 888-234-5464 for more information.