1(self.webpackChunk_N_E=self.webpackChunk_N_E||[]).push([[2977],{40089:(e,i,s)=>{"use strict";s.r(i),s.d(i,{default:()=>x});var t=s(37876),r=s(12494),n=s(90514),a=s(91368),o=s(96792),d=s(72734),l=s(48230),c=s.n(l);let h=({bold:e})=>(0,t.jsxs)(t.Fragment,{children:[(0,t.jsx)(o.G3,{bold:e})," testing"]}),p=()=>(0,t.jsx)(o.DF,{$background:"light",children:(0,t.jsxs)(o.j8,{children:[(0,t.jsx)(o.yF,{children:(0,t.jsx)(c(),{href:a.Xp.routes.Provider.login(),children:(0,t.jsx)(n.A,{width:"200px"})})}),(0,t.jsxs)("h2",{children:[(0,t.jsx)(o.G3,{})," Insurance Billing FAQ"]}),(0,t.jsx)("em",{children:"Information for Physicians and their Staff"}),(0,t.jsx)("hr",{}),(0,t.jsx)("small",{children:"Updated February 5, 2026"}),(0,t.jsxs)("h4",{children:["What is the Service Fee for the ",d.s2," test?"]}),(0,t.jsxs)("p",{children:["The ",(0,t.jsx)(o.yl,{})," laboratory service fee is $4,000. The"," ",(0,t.jsx)(o.L0,{})," laboratory service fee is $3,800."]}),(0,t.jsxs)("h4",{children:["What CPT codes does ",d.s2," bill"," ",(0,t.jsx)(h,{})," under, and is there an established price for the ",(0,t.jsx)(h,{})," on the Medicare Clinical Laboratory Fee Schedule?"]}),(0,t.jsxs)("p",{children:["The PLA Code for ",(0,t.jsx)(o.yl,{})," is 0534U and is used when filing insurance claims. CMS has not yet set a rate on the Clinical Laboratory Fee Schedule for this code. The CPT Code for"," ",(0,t.jsx)(o.L0,{})," is 81479."]}),(0,t.jsx)("h4",{children:"What is a PLA Code?"}),(0,t.jsx)("p",{children:'PLA stands for Proprietary Laboratory Analysis Code, and it is assigned to a specific test if the performing Laboratory requests the AMA to grant it a code to describe proprietary clinical laboratory analyses that is provided by a single ("sole-source") laboratory, which is not otherwise described in the current set of CPT Codes.'}),(0,t.jsxs)("h4",{children:["Is ",(0,t.jsx)(h,{})," covered by Medicare?"]}),(0,t.jsxs)("p",{children:["Currently, there is no coverage policy for ",(0,t.jsx)(h,{})," ","issued by Medicare."]}),(0,t.jsx)("h4",{children:"How do you expect the Insurance Company to respond to the claim(s) - will it be covered?"}),(0,t.jsx)("p",{children:"Each insurance company will adjudicate the claim(s) based on its current medical policy. We expect that some insurance companies will cover and pay for the test, and others will not."}),(0,t.jsxs)("h4",{children:["What if the Insurance Company denies covering"," ",(0,t.jsx)(h,{}),"\xa0 and doesn't pay for the service?"]}),(0,t.jsxs)("p",{children:["We anticipate that many Insurance Companies will deny covering"," ",(0,t.jsx)(o.G3,{})," tests upon initial claim submission."," ",d.s2," will appeal their determination and attempt to overturn the denial. However, if the appeal is unsuccessful, and"," ",(0,t.jsx)(o.G3,{}),'\xa0 tests are deemed "non-covered" and/or "not paid," the patient will not be financially responsible for paying for ',(0,t.jsx)(h,{}),"."]}),(0,t.jsxs)("h4",{children:["What if the Insurance Company determines that"," ",(0,t.jsx)(h,{})," is a covered service?"]}),(0,t.jsxs)("p",{children:["If insurers deem ",(0,t.jsx)(h,{})," a covered service,"," ",d.s2," is required to bill patients the amount directed by their insurers, which is their deductible and/or co-insurance."]}),(0,t.jsxs)("h4",{children:["Does ",d.s2," offer a Financial Assistance Program?"]}),(0,t.jsxs)("p",{children:[d.s2," is committed to minimizing patient financial burden and has a generous patient-friendly Financial Assistance Program (FAP) to assist with any out-of-pocket expenses associated with the test. Patients can easily opt into the FAP at the time of ordering or shortly thereafter, and the maximum out-of-pocket cost for qualified patients will not exceed $295 per test."]})]})}),x=()=>(0,t.jsx)(r.A,{children:(0,t.jsx)(o.DF,{$background:"light",children:(0,t.jsx)(p,{})})})},54481:(e,i,s)=>{(window.__NEXT_P=window.__NEXT_P||[]).push(["/provider/prostox-billing",function(){return s(40089)}])},90514:(e,i,s)=>{"use strict";s.d(i,{A:()=>c});var t=s(37876),r=s(54587),n=s.n(r),a=s(99831),o=s(12576),d=s(86320),l=s(45904);let c=({width:e,height:i,margin:s,isVisible:r=!0})=>{let c=(0,d.e)();if(!r||!c)return null;let h=(0,a.eK)(e)??300,p=(0,a.eK)(i)??.319*h,x=Math.min(h,160),u=c===l.yo.MiraKind?"mirakindLogo":"miradxLogo";return(0,t.jsx)("div",{"aria-label":"Logo",className:"relative block",role:"img",style:{width:h,height:p,margin:s??"auto"},children:(0,t.jsx)(n(),{alt:"","aria-hidden":"true",fill:!0,priority:!0,sizes:`(max-width: 768px) ${Math.round(x)}px, ${Math.round(h)}px`,src:(0,o.A)(u),style:{objectFit:"contain"}})})}}},e=>{e.O(0,[4587,636,6593,8792],()=>e(e.s=54481)),_N_E=e.O()}]);
Line numbers count LF bytes from the start of the resource, as the search results do. Vendor segments are library code the classifier recognised; they are stored but not indexed. Bytes are shown as Latin1 characters, one per byte.