The GeneDx Commitment: Working together to ensure that cost is not a barrier to genetic testing.

Our dedicated team of billing experts is available to answer patients’ questions so you can focus on providing the best care.

Billing Options

GeneDx accepts all commercial insurance, Medicare, and Medicaid, and Tricare and encourages prior authorization (PA) for all test orders. We can also bill your institution directly, offer self-pay pricing, and provide a Financial Assistance Program (FAP) for eligible patients. 

Commercial Insurance

We are in-network with many national and regional health plans. For a complete list of in-network plans, please refer to our In-Network Contract List.

Some commercial health insurance plans may require additional documentation to complete the prior authorization and/or billing process. You can access those forms here.

How to Help Ensure a Smooth Billing Process with Commercial Insurance

We encourage you to submit a prior authorization and supporting documentation up front with the test order. This clinical information can also help us uncover more actionable answers for your patients. Here are some common medical policy requirements used to determine coverage for whole exome sequencing (WES):

• Meeting disease-specific criteria, which include clinical and family features
• Completion of payer required prior authorization (PA) before testing
• Genetic counseling by a qualified entity other than the laboratory performing the testing, occurring both pre- and post-test
• Pre-test patient evaluation by a specific medical specialist, most commonly those with documented expertise (medical geneticist, neurologist, developmental pediatrician, neonatologist)
• Provider-completed documentation to support medical necessity

The above list is not exhaustive, and some items do not apply as payor criteria vary.

Medicaid

GeneDx accepts all Medicaid with prior authorization (PA). We can submit the PA on the providers’ behalf with Medicaid and/or a Managed Care Organization (MCO) if, at the time of order placement, providers include:

• Clinical notes
• Historical medical records supporting the need for testing and show previous tests ordered
• Documentation of genetic counseling (where applicable)
• Any payer-required PA form
  

Medicare

GeneDx is an approved Medicare provider and accepts Medicare as a form of insurance, including Medicare Advantage plans.  

Institutional Billing

Institutional billing allows GeneDx to bill your institution directly and is intended to simplify the test ordering process for the ordering healthcare provider. To establish an institutional account with GeneDx, please reach out to GeneDx Accounts at (888)729-1206, option 4. 

Self-pay

Self-pay pricing varies based on the test ordered. If a patient is interested in self-pay, please select the Patient Bill option when ordering the test(s) in the GeneDx Provider Portal or completing the test requisition form.   

Financial Assistance Program (FAP)

GeneDx understands that when a patient may be facing many other medical expenses, working genetic testing into their budget may be challenging. That’s why we offer a Financial Assistance Program (FAP) to assist eligible patients. The FAP, if approved, can reduce the amount owed for the patient’s responsibility as specified in the explanation of benefits (EOB). Click here to access the FAP forms.

Patients can apply for the FAP before or during the ordering and testing process. If approved, a final bill from GeneDx will reflect the adjusted amount owed. The FAP is not available for:

• Certain commercial health insurance plans
• Patients utilizing self-pay

Prior Authorization Support

We are proud to support providers through the Prior Authorization (PA) process and have partnered with Glidian, a third-party partner, to obtain PAs on your behalf. Glidian works directly with payors to obtain PAs and submits the approval/denial information to GeneDx on behalf of providers. Learn more here.  

Benefits Investigation (BI)

To help patients understand what they may expect to pay out-of-pocket, we offer a Benefits Investigation. This provides an estimate only, and the patient’s insurance determines the final bill.

It’s also important to note that approval or denial of a PA can impact a patient’s final bill, regardless of what estimate a benefits investigation may provide.