COVERAGE AND REIMBURSEMENT

COVERAGE AND REIMBURSEMENT

Please contact the Biodesix Support Hotline at 1.866.432.5930 with any questions you may have regarding coverage and payment.

For patients with Medicare:

  • VeriStrat® is covered by Medicare for patients with non-small cell lung cancer who are EGFR wild-type or whose EGFR mutation status is unknown.
  • The genes tested in GeneStrat are covered by Medicare.

For patients with private insurance:

  •  Biodesix® will file the claim and any necessary appeal with the patient’s insurance company. VeriStrat and the genes tested in GeneStrat have positive medical policy with a large number of National and Regional Health Plans.

Biodesix Assist™ Financial Support Program:

  • If the patient has a financial responsibility, the patient’s insurance does not cover VeriStrat, or the patient does not have insurance, they may be eligible for the Biodesix Assist Financial Support Program, which may help to reduce or eliminate the cost of the test. Call a VeriStrat Patient Advocate to learn more at 1.866.432.5930.

Biodesix’s VeriStrat test has medical policy coverage for over 228 million lives*, including those at:

Aetna
AmeriHealth
BCBS of Michigan
Capital Health Plan
CareFirst BCBS
Cigna
EmblemHealth
eviCore National Lab Management Program Guidelines
Florida Blue
Geisinger
Group Health Cooperative
Health Alliance Plan (HAP) of Michigan
Health Care Services Corporation (HCSC) including BCBS of Texas, Oklahoma, Illinois, Montana, and New Mexico
Health Net, Inc.
Highmark Inc., a BCBS affiliate
Horizon BCBS of New Jersey
Humana
Independence BlueCross
Johns Hopkins Health Care
Medicare
Paramount
PreferredOne
Priority Health Michigan
UCARE
United Healthcare
Wellmark BCBS

*As of 19th October 2017

ICD-10 Codes

ICD-10 CodeCode Description
C33Malignant neoplasm of trachea
C34.00Malignant neoplasm of unspecified main bronchus
C34.01Malignant neoplasm of right main bronchus
C34.02Malignant neoplasm of left main bronchus
C34.10Malignant neoplasm of upper lobe, unspecified bronchus or lung
C34.11Malignant neoplasm of upper lobe, right bronchus or lung
C34.12Malignant neoplasm of upper lobe, left bronchus or lung
C34.2Malignant neoplasm of middle lobe, bronchus or lung
C34.30Malignant neoplasm of lower lobe, unspecified bronchus or lung
C34.31Malignant neoplasm of lower lobe, right bronchus or lung
C34.32Malignant neoplasm of lower lobe, left bronchus or lung
C34.80Malignant neoplasm of overlapping sites of unspecified bronchus and lung
C34.81Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82Malignant neoplasm of overlapping sites of left bronchus and lung
C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
C34.91Malignant neoplasm of unspecified part of right bronchus or lung
C34.92Malignant neoplasm of unspecified part of left bronchus or lung
C38.4Malignant neoplasm of pleura
C45.0Mesothelioma of pleura

Additional information on the ICD-10 transition is available from the Center for Medicare and Medicaid Services (CMS) at https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
Medicare Local Coverage Determination (LCD) L35396 Biomarkers for Oncology. Novitas Solutions. Effective 10/1/2015.
ICD-10 Transition 2015-09-23-01-RE

VIEW OUR BLOGS

ORDER A TEST KIT