Genetic Test Coverage and Payment Guide for Medicare Advantage

A definitive guide to coverage and payment rules for laboratory services

Health plans, labs, clinicians and patients all struggle to accurately determine coverage and reimbursement of genetic tests and other laboratory services. With differing rules for Medicare Advantage (MA) and Original Medicare plans, this is especially true for Medicare beneficiaries.

To clear up this confusion, Concert Genetics enlisted leading experts to provide definitive guidance on key questions, such as:

  • How does coverage determination differ between MA and Original Medicare?
  • What should plans do when criteria is not available in NCD/LCDs?
  • What determines the LCD jurisdiction for lab services?
  • What are the guidelines for using prior authorization in MA plans?
  • Can MA plans establish their own billing, coding and payment policies?
  • Can they negotiate rates that differ from the Clinical Lab Fee Schedule?
  • Do these rules differ for in-network vs out-of-network lab providers?


For access to the new guide, please complete the form on this page.

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