Medicare & Medicaid

Ambry Genetics is approved by Medicare. Collection is based on published Medicare prevailing rates for locality 26/31146. Front and back copy of insurance card should be included. 

 

Medicaid
We work with the majority of Medicaid plans and most require prior authorization 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:

  • To be eligible for Medicare reimbursement for BRCAPlusTM, BreastNextTM or OvaNextTM, the patient must meet Medicare BRCA1/2 testing criteria and not have previously had BRCA1/2 testing
  • To be eligible for Medicare reimbursement for ColoNextTM or RenalNextTM, 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 CancerNextTM or PancNextTM, 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 PGLNextTM, 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. If you have any questions, please call us at (949) 900-5794. You can also fill out our insurance preverification form found here.