PGX Billing

angela1

New
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Hello

Anyone with experience in PGX Billing. Can you please reach out to me. I am new at this. I am not understanding which panels or how many panels to bill.
 

karamac

Networker
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Glendale, Arizona
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Hi Angela,

Sorry that I just saw your post and you may have found another resource. I like to refer to the MolDx website, and Evicore Guidelines. Here is a link to the Palmetto site.


It is a great place to start. Pharmacogenetics can be a little tricky and each laboratory has their own "panels" etc. that they run. The laboratory manager or director should be able to identify on the requisition form the CPT code that alligns to each test or panel. They can then crosswalk and label by result the CPT code that was run. This is something that I make every laboratory that is a client do, as part of my engagement. You should not be asked to try and figure it out, as it is not standard. While there are limited codes, what you have probably already run into is that this testing is quite often a non-covered benefit at most, if not all payers. Or requires prior authorization. I would highly recommend that the laboratory not run the specimen until prior authorization has been run and any patient cost sharing is collected.
 
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