Before Ordering

What to know about billing before ordering a Counsyl screen

Before Ordering

How much does a Counsyl screen cost?

How many times have you found yourself asking this question when it comes to healthcare?

Maybe this is the first time, maybe the hundredth. It’s a challenging topic. Part of the reason it’s challenging is because healthcare and insurance are so multi-faceted.

At Counsyl, we want to remove some of the mystery involved in healthcare costs. That is why we provide a cost estimate once we receive an order from your doctor.

To generate an estimate, we look at the following:

  • Your specific insurance plan (see below)
  • Your medical history
  • Your doctor’s order
  • The CPT codes that are specific to your order

For insurance, the estimate factors in the following:

  • If Counsyl is in-network or out-of-network with your insurance provider
  • If you meet medical criteria required by insurance for coverage
  • The fraction of the total cost that your insurance covers, which varies by plan
  • The amount you have already paid for healthcare expenses this year, known as the remaining deductible

Learn more about your cost estimate >

The test-specific information below is provided to help you learn about what affects your final cost for each test.

If you do not have insurance or have financial concerns, please take a look at the Counsyl Access Program.

Cost Factors

Each Counsyl test is unique

Because each test is unique, the factors involved with the healthcare costs for each are also unique.

Foresight Carrier Screen

Foresight Carrier Screen

There are many individual factors involved in healthcare costs and pricing, such as your specific insurance plan, medical history, your doctor’s order, and the CPT codes specific to your order. Information specific to the Foresight Carrier Screen is provided below. Learn more about the Foresight Carrier Screen.

What is the CPT code for the Foresight Carrier Screen?

Each gene tested has a different CPT code. See the CPT codes for the genes in the Foresight Carrier Screen.

Once you order, we will provide you with a personalized estimate, which will include the CPT codes that are specific to your order.

If you have further questions about what your insurance plan covers, please contact your insurer directly.

What is the medical criteria for insurance coverage?

The Foresight Carrier Screen does not usually have medical criteria. Please check with your insurance plan if you have questions. Take a look at the Counsyl Access Program for more information.

Will I need prior authorization or approval for this test?

This screen does not usually require prior authorization, but it depends on your insurance provider. If it is required, Counsyl will work with your healthcare provider to request an authorization for this screen. Counsyl cannot guarantee that authorization will be provided in all cases and prior authorization is not a guarantee of coverage. Coverage may vary depending on product, location, specific benefit plan or the payor’s medical policy guidelines.

Prelude Prenatal Screen

Prelude Prenatal Screen

There are many individual factors involved in healthcare costs and pricing, such as your specific insurance plan, medical history, your doctor’s order, and the CPT codes specific to your order. Information specific to the Prelude Prenatal Screen is provided below. Learn more about the Prelude Prenatal Screen.

What is the CPT code for the Prelude Prenatal Screen?

Each gene tested has a different CPT code. See the CPT codes for the genes in the Prelude Prenatal Screen.

Once you order, we will provide you with a personalized estimate, which will include the CPT codes that are specific to your order.

If you have further questions about what your insurance plan covers, please contact your insurer directly.

What is the medical criteria for insurance coverage?

It varies depending on the insurer. Women with a pregnancy considered to have a higher chance for a chromosome condition are generally covered for this screen. This includes women who are 35 or older, who have an abnormal ultrasound result, who have a prior affected pregnancy or who have a blood test result indicating there is an increased chance. Many insurers, however, cover all patients. Women who are pregnant with twins, regardless of maternal age, are generally not covered. Take a look at the Counsyl Access Program for more information.

Will I need prior authorization or approval for this test?

This screen may require prior authorization depending on your insurance provider. As needed, Counsyl will work with your healthcare provider to request an authorization for this screen. Counsyl cannot guarantee that authorization will be provided in all cases and prior authorization is not a guarantee of coverage. Coverage may vary depending on product, location, specific benefit plan or the payor’s medical policy guidelines.

Reliant Cancer Screen

Reliant Cancer Screen

There are many individual factors involved in healthcare costs and pricing, such as your specific insurance plan, medical history, your doctor’s order, and the CPT codes specific to your order. Information specific to the Reliant Cancer Screen is provided below. Learn more about the Reliant Cancer Screen.

What is the CPT code for the Reliant Cancer Screen?

Each gene tested has a different CPT code. See the CPT codes for the genes in the Reliant Cancer Screen.

Once you order, we will provide you with a personalized estimate, which will include the CPT codes that are specific to your order.

If you have further questions about what your insurance plan covers, please contact your insurer directly.

What is the medical criteria for insurance coverage?

Individuals with family and/or personal history of cancer are typically covered for this screen. Some insurers treat this DNA test as a preventative treatment, which may mean that you will not pay any of the associated cost. Take a look at the Counsyl Access Program for more information.

Will I need prior authorization or approval for this test?

This screen may require prior authorization depending on your insurance provider. As needed, Counsyl will work with your healthcare provider to request an authorization for this screen. Counsyl cannot guarantee that authorization will be provided in all cases and prior authorization is not a guarantee of coverage. Coverage may vary depending on product, location, specific benefit plan or the payor’s medical policy guidelines.

Counsyl is in-network with most major insurers

At Counsyl, we’re working hard to make genetic information accessible to anyone who wants it. Counsyl has contracted with many health plans to provide patients affordable access to our DNA tests.

What other financial options are available?

Prompt Pay Program

If you have a high out-of-pocket responsibility, a discounted prompt pay price may be available if you submit payment in full within 45 days of your bill.

Financial Assistance

No-charge testing is available to those who qualify.

Apply for financial assistance.

Payment Plans

Interest-free payment plans are available for every patient, regardless of financial need.

Learn about payment plans

Learn more about billing

Counsyl Access Program

Learn more about how we make screening more accessible

How billing works

Learn about Counsyl’s unique billing experience and basic insurance terminology

Before ordering

Learn about each test, what affects your final cost, and available payment options

After ordering

Learn about your estimate and answers to common questions

Invoice & Payment

Understand your bill, how to pay, and available payment options