Billing & Insurance Information

Ambry Genetics works with all of our clients to facilitate easy and convenient billing. Please click the links below to learn more.

Ambry Genetics offers to bill insurance carriers directly and accepts the amount of coverage of the test cost assigned by the insurance company. Ambry does not practice “balance billing” although the patient may be responsible for co-pay, co-insurance and unmet deductibles. When applicable, your patient may be responsible for paying any charges for services determined to be not medically necessary by the insurance carrier. For all 'insurance-bill' samples that are submitted, Ambry will pre-verify patient insurance coverage.  If the estimated patient out-of-pocket costs for co-pay, co-insurance, and/or deductible is greater than $100 (does not apply to Medicare and Medicaid), Ambry will notify the patient. If you would like us to call your patient regardless of the total out-of-pocket costs, please state this on the Ambry test requisition form.


If under any circumstance your patient would like to discuss their Explanation of Benefits (EOB), please contact the Billing Department at (949) 900-5795.

We remain committed to working with you and your patients to make the genetic testing process as simple and cost effective as possible.

Medical Professional Notice Regarding Medical Necessity and Billing Compliance

Institutional Price List (Last updated 7.21.2014)

2014 Price List Sort by Test Code

2014 Price List Sort by Test Name

Due to the dynamic environment we are experiencing with 2013 CPT codes (MoPath Codes), we are making our price list and MoPath codes readily available to you. We will update frequently. Please, check back routinely for the most current client price list.

CPT Codes
View the CPT codes with units to assist in the prior-authorization and billing process.

Learn how to consolidate your send-out tests with Ambry and immediately lower your laboratory operating budgets. 


Institutional Billing

Obtain information about setting up an institutional account.

Insurance Billing & Insurance Preverification Requests
Obtain information for billing patients with insurance coverage/preverfication request form to have us verify insurance coverage and share of cost.  Please allow up 72 business hours for a response. (Due to recent high volume we are experiencing delays.)


Medicaid
We work with the majority of Medicaid plans and most require pre-verification for genetic testing. Please submit for pre-verification by faxing the completed test request form and insurance information to 949-900-5501. You can also call our Billing Department at 949-900-5794 to inquire about a specific Medicaid plan.

Medicare
We are a contracted provider with Medicare. For genetic tests that Medicare has specific testing criteria for, the patient must meet Medicare criteria. If the patient does not meet the explicit Medicare criteria, a completed Advance Beneficiary Notice (ABN) is required. Our insurance pre-verification department can verify coverage and provide you with testing coverage details.

Medicare patients are able to have the following NGS cancer panel tests if they meet the specific criteria for each test as explained below:(Please click here for more information)

  • To be eligible for Medicare reimbursement for BRCAPlus, BreastNext or OvaNext, the patient must meet Medicare BRCA1/2 testing criteria and not have previously had BRCA1/2 testing
  • To be eligible for Medicare reimbursement for ColoNext or RenalNext, the patient must meet Medicare Lynch Syndrome genetic testing criteria and not have previously had Lynch Syndrome genetic testing
  • To be eligible for Medicare reimbursement for CancerNext or PancNext, the patient must meet Medicare criteria for BRCA1/2 or Lynch Syndrome genetic testing and not have previously had BRCA1/2 or Lynch Syndrome testing
  • To be eligible for Medicare reimbursement for PGLNext, please submit for pre-verification

As you know, Medicare is not covering any screening genetic tests for patients who have never had an associated cancer diagnosis. We are not able to bill Medicare if the patient is unaffected and genetic testing is being ordered based only on family history.

Self Pay
Obtain information for patients who will be paying for testing out-of-pocket (due to no insurance or other coverage).

International
Obtain information for clients sending in samples from outside the U.S.

Definitions:

  • Authorization – An approval to perform testing by the insurance company 
  • Preverification – A service Ambry provides to our clients to obtain benefit information (out of pocket costs) and coordinate authorization requirements.
  • Insurance Verification Representative – An Ambry employee who is specialized in obtaining insurance benefits and approvals.
  • OOP – Out of Pocket Costs to the patient
  • ABNAdvanced Beneficiary Notice
  • LOA – Letter of Agreement
  • LMNLetter of Medical Necessity
  • Payer – Insurance Company
  • Carrier – Insurance Company

If under any circumstance your patient would like to discuss their Explanation of Benefits (EOB), please contact the Billing Department at (949) 900-5795.

We remain committed to working with you and your patients to make the genetic testing process as simple and cost effective as possible.