Medicare Coverage for DISCERN™ Test

‍The DISCERN™ test has received reimbursement codes, payment rates and is paid for by Medicare Fee for Service and some Medicare Advantage and Commercial plans. When ordering the test, you will be asked to provide the patient’s insurance information. This information will be used to identify coverage for the patient and estimate out-of-pocket costs, if any.

As part of our service, Synaps Dx will obtain reimbursement directly from the payers, reducing the burden on your practice and on your patients. When patient information is entered into our HIPAA secure portal, Synaps Dx will assess insurance coverage and eligibility with the information provided. When completing the test request, it is important to be as complete as possible with the patient information. This will improve the accuracy of the insurance assessment.

The patient insurance coverage assessment will be provided to the practice to discuss with the patient and confirm patient agreement to conduct the test and accept the identified out-of-pocket costs.A patient authorization and insurance assignment form is Included in the DISCERN™ kit.

This form must be signed by you and the patient. Your signature authorizes the procedure, and the patient signature assigns their insurance benefit for the test to Synaps Dx for collection and has the option to opt out of SynapsDx retaining their sample for future Alzheimer’s Disease research.   If this form is not completed, the test processing could be delayed.

‍DISCERN™ has two PLA Codes assigned:
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• 206U has been assigned for cell culturing and performing the Morphometric Imaging (MI) and PKCƐ assays.
• 207U has been assigned for the AD IndexSynaps Dx will always perform the MI and PKCƐ assays to inform a diagnosis of AD. If the results from these two assays are inconclusive, the AD-Index will be performed as a “tie-breaker.”

The test has been reimbursed by Medicare for Fee for Service and Synaps Dx is working with other payers to ensure reimbursement. If paid for by Medicare, your patient will bear no costs, other than those required to cover any co-pays or co-insurance requirements as outlined by the specifics of their insurance plan.   If their insurance does not cover the test, you will be notified. If your patient wants to proceed, we have cash pay options available. To learn more about cash pay options, contact us at info@synapsdx.com or speak to your DISCERN™ Diagnostic Specialist.

‍The DISCERN™ Test was designed to reduce the burden on your practice. Synaps Dx will perform the insurance discovery and seek reimbursement, provide the tools, transport containers and pre-paid shipping labels to perform the biopsy and return the sample to our lab. Synaps Dx does not provide the local anesthetic (lidocaine), syringe, or any skin adhesives that may be necessary to perform the biopsy. Synaps Dx may be able to reimburse your practice for the costs of these items for performing the DISCERN™ test. To learn more, contact us info@synapsdx.com. Reimbursement for performing the skin punch biopsy may be available. To find out more, please consult your billing department for proper coding and documentation requirements.

The skin punch biopsy procedure is performed under CPT code 11104 and is associated with .83 RVU. Coverage and payment for the skin punch biopsy may vary by payer. Synaps Dx does not make any representation for coverage or payment for the skin punch biopsy procedure. Please consult your billing department to confirm appropriate coding and documentation.

The out-of-pocket cost for the DISCERN™ test is $2,900 when not covered by insurance. However, the actual amount you may need to pay can vary depending on the insurance carrier and the specific details of the insurance plan. We recommend contacting the insurance provider to understand how much of the cost might be covered under the current policy.