How is billing for genetic testing handled?
Outside labs perform genetic testing and we do not bill directly for those. Some insurance companies require that prior authorization is done before testing. If it is required, either the lab or our office will initiate the prior authorization process.
We are not able to obtain the prior authorization or give a cost estimate of your testing options before your appointment. We need to discuss your health and family history, review the ultrasound and discuss which of the multiple testing options and multiple lab companies have the appropriate tests for you.
You can also choose to perform the testing at a later date if you wish to see how your insurance company covers it. If you have an issue with your bill for genetic testing, please call the lab directly (see above). If you still have issues, please call our office for further assistance.
You can call your insurance provider to see if a prior authorization (PA) is required. These are the first trimester codes for when you call.
Common ICD-10 codes
O09.511 Over 35 at delivery (1st pregnancy)
O09.521 Over 35 at delivery (not first pregnancy)
Z36.89 Under 35 at delivery
Common CPT codes
99203 Office Visit/moderate
76801 Diagnostic scan under 14 weeks
76813 First trimester nuchal translucency