As many of you are aware, CMS adopted the AMA defined MoPath 'universal billing' codes eliminating "stacked CPT codes" beginning January 1, 2013. These changes, in combination with incomplete private insurance fee schedules, created uncertainty in the insurance billing process for diagnostic laboratories. Going forward, please use updated test requisition forms (TRFs) to start the testing process. Completing the TRF and submitting to Ambry prior to sample submission constitutes a request for pre-verification.

Additional insurance information requested to ensure quick processing of your order:

• Letter of medical necessity (LMN) - a LMN may be requested by Ambry on behalf of most insurance companies (a LMN is not required for Medicare patients that meet medical guidelines)
• ICD9-codes (provided on page two of all TRFs)
• Clinician and patient signatures
• Copy of patient insurance card

Ambry Genetics offers to bill insurance carriers directly and accepts the amount of coverage of the test cost assigned by the insurance company. For all 'insurance-bill' samples that are submitted, Ambry will pre-verify patient insurance coverage.

If the estimated patient out-of-pocket cost for co-pay, co-insurance, and/or deductible is greater than $300, 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.

By law, patients are responsible for co-pay, co-insurance and unmet deductibles; thus, your patient will be required to pay for these amounts. In addition, when applicable, your patient will be responsible for paying any charges for services determined to be not medically necessary by the insurance carrier.