Is it Covered by Insurance

Insurance is now consistently reimbursing for pharmacogenetic testing in many diagnostic situations including adverse drug reactions or lack of response to medication, pain management, cancer management, and management of many co-morbid conditions.  Genelex has submitted multiple claims with several carriers, almost all of which were paid at an acceptable rate. Please note that we have seen coverage only for relevant medications and conditions not as a general screening. Contact your insurance provider about coverage prior to ordering if this is a concern. Even if it is not covered by insurance, most patients think that the once-in- a-lifetime expense is well worth it when the benefits of testing are considered.

The CPT codes are as follows if you would like to confirm eligibility in advance:

CYP2D6 CPT codes - 1 X 83891, 2 X 83892, 1 X 83900, 17 X 83914, 1 X 83909, 1 X 83912, 1 X 83912-26

CYP2C9 CPT codes - 1 X 83891, 2 X 83892, 1 X 83900, 5 X 83914, 1 X 83909, 1 X 83912, 1 X 83912-26

CYP2C19 CPT codes - 1 X 83891, 2 X 83892, 1 X 83900, 3 X 83901, 7 X 83914, 1 X 83909, 1 X 83912, 1 X 83912-26

CYP1A2 CPT codes - 1 X 83891, 2 X 83892, 2 X 83898, 2 X 83894, 1 X 83912, 1 X 83912-26

NAT2 CPT codes - 1 X 83891, 2 X 83892, 1 X 83900, 7 X 83914, 3 X 83901, 1 X 83909, 1 X 83912, 1 X 83912-26

DPD Enzyme CPT codes - 1 X 83891, 1 X 83892, 1 X 83898, 1 X 83894, 1 X 83912, 1 X 83912-26

UGT1A1 - 1 X 83891, 2 X 83892, 1 X 83898, 1 X 83894, 1 X 83912, 1 X 83912-26

Letter of Medical Necessity

Some insurance companies will ask for a letter from your doctor that confirms this testing is medically important. You can phone your doctor’s office to request this.

ICD-9 Codes

These codes tell the insurance company the medical diagnosis that makes testing necessary.. Your doctor will need to provide these codes. If a letter of medical necessity is required, ICD-9 codes can be included in the letter.

Insurance Company Websites

Aetna
Blue Cross Blue Shield
Cigna
Group Health Cooperative
Group Health Incorporated
Guardian Life Insurance
Health Net
Humana
Kaiser Permanente
Medica
Oxford Health Plans
PacifiCare
UniCare
United HealthCare

Anonymity

Some customers prefer to order testing through Genelex and not use insurance, in order to keep their testing and test results off their medical record. We do not share your information with any third party without your written permission.

Disclaimer

The content of this web site is for public use, free of charge, and for information only. It is not intended to be used in any other way. The authors disclaim any liability, loss, injury, or damage incurred as a consequence, directly or indirectly, of the use and application of any of the content of this web site.

The information presented on this site is intended as general health information and as an educational tool. It is not intended as medical advice. Only a physician, pharmacist, or other healthcare professional should advise a patient on medical issues and should do so using a medical history and other factors identified and documented as part of the health professional/patient relationship.