Medicare and most private insurance carriers cover the Oncotype DX Breast Recurrence Score test for eligible patients with early-stage invasive breast cancer. Since insurance coverage can vary across the country, it’s a good idea to check with your patient’s carrier or contact the Customer Service team to confirm coverage.
In addition, Exact Sciences created the Genomic Access Program (GAP) to help patients navigate the insurance and other payment options for Oncotype DX tests. Through GAP, Exact Sciences takes every possible step to ensure testing is affordable, available, and accessible. To learn more about GAP, contact our Customer Service.
Exact Sciences believes that everyone should have access to the information they need to make confident, informed decisions about their cancer treatments.
The GAP team can:
- Contact insurance companies on patients’ behalf.
- Work with clinicians to get prior authorization from insurance companies (if required).
- Bill insurance companies directly when possible.
- Process the claim once the test is complete.
- With your consent, assist in the appeal process if a claim is denied.
Exact Sciences offers financial assistance programs for eligible patients with financial hardship. These programs are based on financial eligibility. Contact Customer Service by phone at 866-ONCOTYPE (866-662-6897) or email us for more information.
The Medicare 14-Day Rule
Exact Sciences Corporation (Exact) is committed to compliance with all applicable laws, rules and regulations, including billing regulations promulgated by the Centers for Medicare and Medicaid Services (CMS). When a laboratory test such as Exact’s OncoType Dx® test is ordered for a hospital inpatient within 14 days of the patient’s discharge from the hospital, CMS regulations require Exact to bill the hospital directly for that test. This rule is commonly referred to as the “14-day rule.” The 14-day rule is part of CMS’ Date of Service Regulation (42 C.F.R. Section 414.510). As of January 1, 2018, the 14-day rule does not apply to tests ordered for hospital outpatients, and Exact bills Medicare directly for such tests, regardless of their order date.
Exact processes test orders as they are received from ordering providers. Clinical judgment should be the determining factor regarding when tests are ordered and Exact does not seek to influence the timing of test orders for any given patient due to billing or other reasons.