Medicare beneficiaries may be eligible for Invitae panel testing when specific criteria are met. These criteria are based on Medicare’s current criteria as well as clinical practice guidelines from professional organizations. Patients who meet these criteria can expect to pay nothing out of pocket. Patients who do not meet these criteria are encouraged to consider Invitae’s $475 upfront patient-pay option.
To place a Medicare order, please submit a criteria form. There are four different versions of the criteria form; please use the version that applies to the disease with which the patient is personally affected. We cannot bill Medicare for unaffected patients; these patients are eligible for the $475 upfront patient-pay option, or Invitae can work with the patient’s stand-alone secondary insurance plan.
Medicare criteria forms include:
- Medicare ordering form: Hereditary breast & ovarian cancer (HBOC)
- For patients affected with symptoms associated with breast and ovarian cancer
- Please utilize the last checkbox on this form if your patient does not meet the stipulated criteria for HBOC but you believe genetic testing is medically necessary
- Medicare ordering form: Lynch syndrome
- For patients affected with symptoms associated with endometrial, colon or other GI cancers
- Please utilize the last checkbox on this form if your patient does not meet the stipulated criteria for Lynch syndrome but you believe genetic testing is medically necessary
- Medicare ordering form: Cardiology
- For patients affected with symptoms associated with hereditary cardiovascular diseases
- Medicare Attestation of Medical Necessity
- For patients affected with symptoms associated with another hereditary condition (e.g., not one of the above) and where you believe genetic testing is medically necessary
These forms can be found on the Forms section of our website. Because Invitae’s criteria is more expansive than Medicare criteria, we request that a pedigree and detailed letter of medical necessity be included to support any appeals that may be necessary. Even if appeals are unsuccessful, we will not balance bill the patient as long as they met the criteria listed in the relevant Medicare ordering form. Note that although patients may receive an explanation of benefits from Medicare, this is not a bill.
For patients who do not meet criteria listed on Invitae’s Medicare ordering forms but have stand-alone secondary insurance coverage, please inform Invitae’s billing team that you would like to assess the patient’s secondary insurance for coverage. We will review the secondary insurance plan to see if it will cover what Medicare will not.
Please direct any questions to Client Services at 1-800-436-3037.