Medicare pays for genetic testing when specific criteria are met. Healthcare providers should consult Medicare's web site to determine if the patient meets Medicare's testing criteria for genetic testing. Healthcare providers can also obtain assistance in interpreting the criteria from Myriad's Medical Services by calling Myriad at 800-469-7423, option 2.
For all Medicare patients, a copy of the signed informed consent is required before testing will begin. For patients who do not meet Medicare criteria, an Advanced Beneficiary Notice of Non-coverage (ABN for Hereditary Cancer) (ABN for Personalized Medicine) is also required before testing will begin.
Because Medicare will likely not cover test costs for patients who do not meet Medicare criteria, test costs will be billed to the patient. A summary of instructions and documentation requirements for Medicare patients is included on page one of the ABN.
Annual Notice to Providers
Medicare, Medicaid, or other federally funded programs will pay only for tests that meet their coverage criteria and are reasonable and necessary to treat or diagnose a patient. Medicare generally does not cover routine screening tests even if the physician or individuals authorized by law to order tests considers the tests appropriate for the patient.
Laboratories are required to provide annual notice of these restrictions to physicians and other individuals ordering laboratory services. Here you will find an electronic copy of those notices.