AccessDx Laboratory (AccessDx) aims to provide cost-effective pharmacogenomic testing for all patients. We’ve implemented a patient-friendly and transparent billing process that supports different payment options at the point of test ordering, including:
- Insurance Billing
- Patient Self-Pay
- Institutional Billing
1. Insurance Billing
Commercial Insurance
Many insurance plans cover PGx testing, depending on the plan and the reason the test was ordered. The out-of-pocket cost of PGx testing varies depending on the patient’s health insurance coverage.
If AccessDx expects the patient to be billed for all or a portion of the test, the patient will be contacted by phone before sample processing. When contacted, the patient will have 72 hours to respond to AccessDx to confirm whether they’d like to use Express Pay or have their insurance provider billed.
If the patient does not respond within 72 hours, AccessDx will process the sample and once resulted, AccessDx will bill the patient’s insurance. Once the sample has resulted, Express Pay will no longer be available.
If the patient chooses Express Pay, the amount paid will not apply toward the annual deductible or out-of-pocket costs for the patient’s insurance plan, and no claim can be submitted to the insurance for reimbursement.
Government Insurance
The Centers for Medicare & Medicaid Services (CMS) covers PGx depending on the policy and the medical necessity for testing, as outlined in their Local Coverage Determination (LCD) L39063, effective 12/12/2021.
CMS covered indications included in the LCD referenced above are below:
“Pharmacogenetics testing will be considered medically reasonable and necessary if:
- The patient has a condition where clinical evaluation has determined the need for a medication that has a known gene-drug interaction(s) for which the test results would directly impact the drug management of the patient’s condition; AND
- The test meets evidence standards for genetic testing as evaluated by a scientific, transparent, peer-reviewed process and determined to demonstrate actionability in clinical decision making by CPIC guideline level A or B; or is listed in the FDA table of known gene-drug interactions where data support therapeutic recommendations or a potential impact on safety or response or the FDA label;
https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling;
https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations”
2. Patient Self-Pay
If a patient does not have insurance, they will be billed directly by AccessDx for testing. AccessDx accepts payments from credit or debit cards, as well as HSA and FSA accounts.
The patient’s sample will not be processed until payment is received or a payment plan is established.
3. Institutional Billing
Institutional billing is available. Please contact AccessDx to review the institutional billing options at 888-958-2298.
