Insurance forms

Below are forms related to the insurance billing process, including templated letters of medical necessity and forms related to the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. 

Insurance plans often require specific prior authorization forms for genetic testing. While many of these forms are available in the GeneDx Provider Portal, please check with your patient’s insurance provider for the latest requirements.

Medical necessity templated letters

Exome templated letter

Genome templated letter

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) forms by state

Please see the EPSDT state attestation forms below. If your patient resides in the following states, physicians should use the general EPSDT attestation form linked below:  Alaska, Colorado, Delaware, District of Columbia (D.C.), Hawaii, Kansas, Louisiana, Maine, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, Rhode Island, South Carolina, Vermont, and Wyoming.

General EPSDT attestation form

The following states require a state-specific EPDST form:

Alabama

California

Massachusetts

Texas