Billing process
GeneDx testing can be billed to a patient’s insurance, to an institutional account, or directly to a patient (self-pay). GeneDx accepts all commercial insurance, Medicaid, Medicare and Tricare plans. We are proud to be in-network with many national and regional health plans.*
Insurance carriers are increasingly covering exome and genome testing. But as with all medical tests, patients may still receive a bill if they have not yet met their yearly plan deductible or if their plan requires coinsurance. GeneDx offers a variety of Patient Access Solutions to help.
Billing options
Patient insurance
Select the “Patient Insurance” option and include a copy of the card as well as any prior authorization information on the order.
Institutional billing
Reach out to GeneDx Accounts at 888-729-1206 to establish an institutional account with us.
Patient self–pay
Select the “Patient Bill” option in the GeneDx provider ordering portal or on the test requisition form.
Insurance requirements
For all insurance types, the following documents should be included at the time of the test order to increase the chance of insurance approval and help reduce back-and-forth for you and your patients.
Prior authorization, if obtained in advance
A prior authorization is almost always required by insurance for genetic testing. GeneDx encourages ordering providers to obtain a prior authorization in advance of placing an order. However, in most cases GeneDx can submit the authorization request to insurance on behalf of the ordering provider through our third-party vendor, Careviso. Click here to learn more.
Supporting documentation that demonstrates why the test is medically necessary, including:
- Documentation of why exome/genome is the most appropriate test for your patient based on their personal and family history (e.g., clinical notes and previous test results)
- Documentation of how testing results could potentially impact management, including explicit details and examples (e.g., clinical notes)
- If applicable, documentation that genetic counseling was performed (e.g., separate genetic counseling consult note or documentation of counseling by the ordering provider)
Insurance-required prior authorization form, if applicable
A copy of the patient’s primary insurance card (front and back)
GeneDx accepts all Medicaid plans
GeneDx accepts all Medicaid plans and coverage for exome sequencing is expanding. In certain states without explicit Medicaid coverage for exome sequencing, patients may be able to obtain coverage for testing through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program.
GeneDx accepts all Tricare plans
If a prior authorization (PA) is obtained in advance of placing the order, then proof of an approved PA should be included at the time of test order. If not obtained in advance, to ensure a smooth billing process and avoid delayed results, all of the following should be included at the time of the test order for patients with a Tricare insurance plan:
Tricare PCM referral document for all Tricare East and West members with Prime and U.S. Family Health Plan.
One of the following:
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The appropriate Tricare Laboratory Developed Test (LDT) attestation form
Supporting documentation that demonstrates why the test is medically necessary, including:

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- Documentation of why exome/genome is the most appropriate test for your patient based on their personal and family history (e.g., clinical notes and previous test results)
- Documentation of how testing results could potentially impact management, including explicit details and examples (e.g., clinical notes)
- If applicable, documentation that genetic counseling was performed (e.g., separate genetic counseling consult note or documentation of counseling by the ordering provider)
In-network coverage
GeneDx is proud to be in network with many commercial and government payors.
Patient access solutions
GeneDx is continually developing solutions aimed at increasing access to genetic testing.
More insurance companies now cover genome testing
GeneDx accepts all plans for outpatient genome test orders. You’ll find a list of insurance companies with publicly available coverage policies for genome sequencing. However, if a payor is not listed, this does not mean coverage isn’t possible—many insurers determine medical necessity on a case-by-case basis, even without a published policy.
Prior authorization support with Careviso
We understand that prior authorizations can be a challenging part of the insurance billing process, so we’ve partnered with a third party, Careviso, to obtain prior authorizations on your behalf. Careviso works directly with payors to obtain prior authorizations for your GeneDx test orders.
Some insurance companies, such as UnitedHealthcare and many Blue Cross Blue Shield plans, require ordering providers to complete enrollment with Careviso in order to access their prior authorization services for patients with those insurance plans.
