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Billing Information

For many payers, including but not limited to Medicaid, HMOs, and Managed Care organizations, preauthorization is required for PGx testing. This means that before a PGx test can be processed, we must receive pre-authorization from the patient’s insurance provider. It is the responsibility of the ordering physician’s office to obtain this pre-authorization.

The pre-authorization must accompany the PGx test requisition form. This documentation should clearly indicate the approval for the test and include the necessary ICD-10 medical necessity diagnosis codes. We are unable to process any PGx test without the pre-authorization and corresponding diagnosis codes upfront. Submitting incomplete requisitions will significantly delay testing and patient care. Please ensure the pre-authorization includes the specific test being ordered and the approved units.

Most insurance providers require us to bill patients for any deductible, co-insurance, and co-payment amounts. For patients with higher out-of-pocket costs, Exceldx offers payment plans. For more information, contact our billing department at 877-202-7019 ext 1.
We understand that pre-authorization may not always be approved. For patients whose insurance denies coverage, we offer a cash pay option for PGx testing. The cost of the test is $300. For qualifying patients, we offer a payment plan option, allowing the $300 fee to be spread over three months.
For patients choosing the cash pay option, we require full completion of the financial agreement before the PGx test is processed. Please ensure all necessary paperwork is completed and submitted prior to testing. For cash pay patients, the $300 payment is due at the time of testing, unless a payment plan has been approved.
To ensure a smooth and efficient process, we ask for your full cooperation in obtaining preauthorization for all applicable patients. Please communicate these requirements clearly to your patients and ensure they understand the process. Providing complete and accurate information upfront is crucial for timely processing.
  • Physician Responsibility:
    Obtaining pre-authorization is the responsibility of the ordering physician’s
    office.

  • Complete Requisitions:
    If pre-authorization is required, requisition must be accompanied by the preauthorization and appropriate ICD-10 diagnosis codes.

  • Cash Pay Agreement:
    For cash pay patients, the financial agreement must be completed before testing.
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