Send Samples Order Submission Kit Test Requisition Form Shipping Information Billing Information     Site Map Ambry Forms

Billing Inquiries
For billing questions call
Client Services 866-262-7943 or SUBMIT your question online.

Billing Information

All billing requirements must be met prior to sample processing. Please make sure the patient financial acknowledgment is signed and all details requested are complete.

Convenient Billing Options:
Insurance
     Medicaid
     Medicare
     Patient Care Plan
    
Institution Billing
International Samples
Payment Options
     Pre-Payment
     Credit Card Payments
     Wire Transfers
Online Billing Inquiries

Insurance

All insurance cases must come with a completely filled out Test Requisition/Billing Form and also with HMO authorizations/referrals and ICD-9 code.

Attach a copy of the front and back of patients insurance card for both primary and secondary insurance carriers. If insurance card is not available, a copy of patient's demographic information or the Registration/Billing form should be submitted.

Status of benefits must be verified for all insurance samples before processing. All tests not authorized by the patient’s insurance will be the responsibility of the patient. Ambry Genetics will inform the client and patient of partial or full payment responsibility based on the patient’s current insurance coverage.

If you would like Ambry Genetics to check your patient’s insurance coverage before sample collection, please complete and fax us the following form. We will repond as quickly as possible.

Insurance Preverification Request | Adobe PDF Document

Ambry Genetics is contracted with the following insurance carriers:

• Blue Cross
• Blue Shield
• Child Health Plan Plus – CHP
• Community Care Network – CCN
• Coalition America, Inc.
• First Health
• Great West Health
• Harvard Pilgrim Health Care
• HUMANA / Choice Care
• Medavant (NPPN)
• Medicare Railroad
• Multiplan
• PHCS PPO/Open Access Networks
• PPO Next

Patient Care Plan

Some insurance companies do not always provide full payment for innovative genetic testing. Because we believe the Ambry Test provides the most comprehensive analysis currently available, Ambry Genetics has established our Patient Care Plan to assist patients with their insurance companies. The Patient Care Plan was designed to contain a patient’s out of pocket costs to no more than 15% of the amount billed for Ambry tests (excluding any deductible and non-covered items if applicable).

Medicare

Ambry Genetics is approved by Medicare and follows the same billing policy as with private insurance carriers. Collection is based on published Medicare prevailing rates locality 26/31146.

Medicaid

Ambry Genetics is a participating provider in the following states:

• Arizona
• Alabama
• Colorado
• Idaho
• Illinois
• Kansas
• Louisiana
• Maine
• Michigan
• Minnesota
• Montana
• Nebraska
• New Jersey
• New Mexico
• Ohio
• Oklahoma
• Utah
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

Institution Billing

Referring clinics, hospitals, labs, and/or physicians may establish institution contracts with convenient invoicing and payment options. Please contact us for details.

The following CPT Codes for The Ambry Test reflect Ambry Genetics’ interpretation of CPT coding requirements based on AMA guidelines and they are required to obtain insurance authorization when necessary.

Ambry Test®: 508 FIRST™
83891, 83892, 83894, 83898, 83912

Ambry Test: CF Full Gene Analysis
83891, 83894, 83898, 83903, 83904, 83909, 83912

Ambry Test: CF AMPLIFIED™
83891, 83894, 83898, 83900, 83901, 83903, 83904, 83909, 83912

Ambry Test: CF Del/ Dup
83891, 83894, 83900, 83901, 83909, 83912

Ambry Test: TG Repeat
83891, 83894, 83898, 83904, 83909, 83912

Pancreatitis Panel (CFTR, PRSS1, SPINK1)
83891, 83894, 83898, 83903, 83904, 83909, 83912

Pancreatitis Panel AMPLIFIED (CFTR AMPLIFIED, PRSS1, SPINK1)
83891, 83894, 83898, 83900, 83901, 83903, 83904, 83909, 83912

PRSS1
83891, 83894, 83898, 83903, 83904, 83909, 83912

SPINK1
83891, 83894, 83898, 83903, 83904, 83909, 83912

Ambry Test: Alpha-1-Antitrypsin
83891, 83894, 83898, 83904, 83909, 83912

Ambry Test: Aminoglycoside-Related Hearing Loss
83891, 83894, 83898, 83904, 83909, 83912

Ambry Test: ABCA3
83891, 83894, 83898, 83904, 83909, 83912

Ambry Test: Surfactant Protein B
83891, 83894, 83898, 83904, 83909, 83912

Ambry Test: Surfactant Protein C
83891, 83894, 83898, 83904, 83909, 83912

Ambry Test: Beta Globin
83891, 83894, 83898, 83904, 83909, 83912

Ambry Test: Canavan AMPLIFIED™
83891, 83894, 83898, 83900, 83901, 83904, 83909, 83912

Ambry Test: Tay-Sachs Plus
83891, 83894, 83898, 83904, 83909, 83912

Ambry Test: Maternal Cell Contamination
83894, 83898, 83909, 83912

Specific mutation analysis (any gene)
83891, 83894, 83898, 83904, 83909, 83912

CPT codes are provided only as a guide to assist you in billing. CPT coding is the sole responsibility of the billing party.

International Samples

International samples must be prepaid unless an institution has already established an account prior to sample submission. An e-mail address is required to establish an international institutional account. The account ID will be communicated by e-mail once the payment information is verified and all required information is received. Please submit check, money order, credit card, or wire transfer payment with single samples (see Payment Options).

Payment Options

Pre-Payment

Individual prepaid samples receive discounted institution fees when the required payment is received with the sample. We accept checks, money orders, credit card payments, and wire transfers. Please make checks and money orders payable to Ambry Genetics. There is a $20.00 processing fee for insufficient check payments.

Credit Card Payments

Approved credit card (AMEX, Discover, MasterCard, or Visa) payments are accepted. The card type, cardholder name and signature, credit card account number, expiration date, and contact phone number must be provided.

Wire Transfers

Payments can be made via wire transfer from your bank. Please contact Kristen Jones at kjones@ambrygen.com for more information.

Online Billing Inquiries

Please fill out the following information:

Indicates a required field

FIRST NAME LAST NAME TITLE COMPANY PHONE EMAIL ADDRESS 1 ADDRESS 2 CITY STATE ZIP CODE COUNTRY REQUESTOR TYPE   - Drop Down for Selection - Allergist, Immunologist Billing Coordinator CF Coordinator CF Director Patient Family Member / Friend Dietician Ear, Nose, and Throat Gastroenterologist Gastroenterologist – Pancreatic Genetic Counselor Geneticist Infertility Specialist Internal Medicine Laboratory Manager Pulmonologist Pediatric Pulmonologist Nurse Obstetrician / Gynecologist Oncologist Sperm Bank Urologist OTHER NOTES: (ONLY PRESS SUBMIT ONCE)