.png)
Genetic testing billing and insurance made simple
Find billing and insurance information for GeneDx genetic testing orders, including coverage requirements and prior authorization support.
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.
Genetic testing cost, insurance coverage and financial assistance
The cost of genetic testing can vary based on the test ordered, insurance coverage, prior authorization requirements, and individual plan details such as deductibles and coinsurance.
For exome and genome testing, coverage and out-of-pocket costs may vary depending on the patient’s insurance plan, clinical indication, and payer requirements.
- GeneDx testing may be billed to a patient’s insurance, to an institutional account, or directly to a patient through self-pay.
- GeneDx offers billing support and patient access solutions, including financial assistance programs and sponsored testing programs, to help patients and providers better understand coverage requirements and potential out-of-pocket costs.
- Flexible payment options are available, including interest-free payment plans. For more information please contact our billing team.
What can affect the cost of genetic testing?
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.
Clinician’s guide to an insurance-ready genetic testing order
Submitting complete clinical and insurance information upfront can help streamline the review process, support timely access to the right test, and help patients make the most of their insurance benefits.
Insurance reviewers can only evaluate medical necessity using the information submitted with an order. Providing a complete clinical picture is critical. Explore resources to help document medical necessity, navigate insurance requirements, and prepare a complete order for coverage review.
Clinical notes and medical necessity
What do insurers want to see in your clinical notes?
A complete clinical note is one of the most effective ways to document medical necessity for genetic testing. Insurers look for the clinical rationale that supports testing for your patient.
Include why testing is appropriate, relevant prior testing, how results could impact the patient’s care, and documentation that the patient was informed about possible results, limitations, risks, and benefits.
See the 5 questions your clinical note should answer
Prior authorization
Prior authorization is often required for genetic testing, but GeneDx is here to help. In most cases GeneDx can submit the authorization request to insurance on behalf of the ordering provider through our third-party vendor, Careviso.
Careviso helps navigate payor-specific requirements, forms, submission pathways, and supporting documentation needed for the request.
When possible, obtain authorization before ordering and include the approval letter or authorization number with your submission.
ICD-10 codes
Include a comprehensive list of ICD-10 codes that reflects the patient’s full clinical presentation, including codes beyond the primary indication for genetic testing.
Providing all relevant ICD-10 codes gives insurers a more complete picture of the patient’s clinical presentation when evaluating medical necessity.
Explore common ICD-10 codes that may be relevent to your patients.
Patient consent and insurance information
- Include a copy of the patient’s primary insurance card (front and back)
- Signed Patient Consent can be submitted with the sample or uploaded in the Provider Portal when ordering.
Preparing for your patient testing? Use our patient consent resources to support conversations about possible results, benefits, risks, and limitations of genetic testing.
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.
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:
The appropriate Tricare Laboratory Developed Test (LDT) attestation form
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)
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.
Ready to bring genetic testing into your practice?
We’re here to support every step.