This page includes information on several payors and their unique requirements.
Myriad’s testing services are reimbursed by hundreds of insurance plans. Although each situation is unique, the average patient pays a coinsurance of less than $100.
Below, we have highlighted a few payors with unique requirements. If you have questions about your specific insurance plan benefits, please call Myriad’s customer service at 800-469-7423.
Medicare pays for genetic testing when the test is considered medically necessary and the criteria in applicable Local Coverage Determination policies are met.
Medicare claims for services performed at Myriad Genetic Laboratories, Inc. are processed by the Medicare Administrative Contractor (MAC) for the state of Utah, Noridian Healthcare Solutions, LLC. Noridian has implemented the coverage policies and procedures of the MolDX program. More Information.
Providers should consult Local Coverage Determination MolDX: BRCA1 and BRCA2 Genetic Testing to determine if their patient meets criteria for genetic testing.
Providers should consult Local Coverage Determination MolDX: Lynch Syndrome Genetic Testing to determine if their patient meets criteria for genetic testing. Download the Supplementary Information Form to order COLARIS for your Medicare patients.
Effective November 1, 2017, UnitedHealthcare (UHC) will require the Ordering Provider to submit a notification/prior authorization for certain genetic and molecular tests and for certain UHC covered lives via a web-based portal with the process and portal managed by Beacon Laboratory Benefit Solutions, Inc. (BeaconLBS), a lab services management company.
All laboratories offering genetic testing services including in-network laboratories such as, Myriad Genetic Laboratories, Crescendo Biosciences, and Assurex Health are impacted by this program.
At this time, UHC’s program and requirement is limited to certain commercial, fully-insured lives with the exception of commercial plans listed below, and does not apply to any Medicaid (UHC Community Plan) or Medicare plans. Program applies to Providers in all states with the exception of Florida where Providers are already subject to the ongoing Laboratory Benefit Management Program. Exempt commercial plans:
- Neighborhood Health Partnership (NHP)
- Sierra Health
- UHC of the Mid-Atlantic
- UHC Oxford
- UHC of the River Valley
- UHC West
- For more information about program overview, please refer to any of the following links on UHC’s website:
- https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2017/network-bulletin/October-Interactive-Network-Bulletin-2017.pdf page 18, UnitedHealthcare Genetic and Molecular Lab Testing Notification/Prior Authorization Requirement
- For further program/member eligibility verification, please access “LINK” on www.UHCprovider.com using your Optum ID > select “Genetic and Molecular Test” app > enter patient/member’s subscriber #
- Follow above steps to also initiate and submit a prior authorization
- For UHC covered lives that are deemed “out of scope” for this program, Myriad will continue to facilitate the authorization request once the specimen with a completed Test Request Form is received. Should UnitedHealthcare deny testing, your patient will be notified of any out of pocket expense and payment options before test release.
- For more details and specific genetic testing criteria/requirements, please refer to UHC’s published medical policy titled “Genetic Testing for Hereditary Cancer”, available at: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/index/commercial/genetic-testing-hereditary-breast-ovarian-cancer-syndrome-11117.pdf
Aetna requires that BRACAnalysis products be pre-authorized.
COLARIS and COLARIS AP testing is subject to Aetna medical criteria. Should you need assistance interpreting the criteria, please contact Myriad’s Medical Services Department at 800-469-7423. Aetna’s Genetic Testing Policy