Insurance & Billing FAQ
Find answers to the most common questions about NavDx® insurance coverage and billing. If you don’t see the answer you need, contact our Patient Insurance Support Team at billing@naveris.com or (833) 628-3747.
Is there a CPT® code for NavDx® testing?
Yes. The NavDx test has a dedicated Proprietary Laboratory Analysis (PLA) code. The PLA code for NavDx testing is 0356U.
What is a PLA code?
Proprietary Laboratory Analyses (PLA) Codes are an addition to the CPT® code set approved by the American Medical Association. A PLA code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Use of a PLA code allows labs to specifically identify their unique test when filing claims with insurance companies.
What is an MAAA code?
Multianalyte Assays with Algorithmic Analyses (MAAA) codes are a specialized subset of diagnostic tests that meet specific criteria for utilizing multiple results derived from various types of lab analysis. The results of these multiple lab analyses are then processed using an algorithm to develop a final test result, often reported in the form of a numeric score(s) or as a probability. MAAA codes are often assigned to some of the most advanced laboratory diagnostic tests.
The NavDx test code is an MAAA code because it employs multiple lab analytes that are then input into our proprietary algorithm to produce a TTMV Score, which is the result that is reported to physicians and patients.
How much does a NavDx test cost?
Naveris® is committed to ensuring that NavDx testing is accessible to patients by providing support services, as well as financial assistance to those who qualify. Our Billing Team works with patients to navigate cost-associated barriers to testing. The cost of NavDx testing depends on your insurance plan and whether or not you have reached your out-of-pocket deductible or co-insurance limits. You are only financially responsible for the insurance plan-associated costs for a NavDx test (such as copays, coinsurance, or deductibles); the amount of these payments is based on the terms of your insurance plan. If you have questions or want to learn more about the cost of the NavDx test, please contact our Patient Insurance Support Team at billing@naveris.com or (833) 628-3747.
What is the billing process after my test is completed?
Naveris manages the billing process for patients. After a NavDx test report is sent to your doctor, Naveris will submit a claim (a bill) to your insurance plan. For some insurance plans, Naveris may contact you to get required information before we can submit a claim. You may receive notification of the claim submission to your insurance plan.
You may then receive an Explanation of Benefits (EOB) from your insurance plan (print or electronically). An EOB is not a bill for you to pay. An EOB is a statement from your insurance plan that describes the amount that your insurance company will pay for a NavDx test and the amount that you are responsible for paying (copays, coinsurance, or deductibles).
Once Naveris is informed by your insurance plan of the amount that you are financially responsible for paying, Naveris will send you a bill for that amount.
Is NavDx testing covered by insurance?
Medicare covers serial NavDx testing for surveillance of recurrence in patients with a history of documented HPV-driven oropharyngeal or anal cancer. The NavDx test is also covered by many commercial health insurance companies, and we are continually pursuing and gaining coverage to ensure patients have access to the test. In the event NavDx testing is not covered by a patient’s insurance plan, Naveris may appeal to the insurance company on the patient’s behalf. Please contact our Patient Insurance Support Team at billing@naveris.com or (833) 628-3747 with any questions about insurance coverage or billing policies.
What if my insurance denies coverage?
If NavDx testing is not covered by your insurance plan, Naveris will appeal to your insurance company on your behalf at no additional cost to you. Our Patient Insurance Support Team manages this process and will keep you informed. For questions, contact billing@naveris.com or (833) 628-3747.
How long does it take to receive a bill after my test?
After your NavDx results are reported to your Provider, Naveris submits a claim to your insurance. Your insurance processes the claim and notifies Naveris of any amount you are responsible for (you are only financially responsible for your insurance plan-associated costs for the NavDx test, such as copays, coinsurance, or deductibles). Naveris then sends you a statement for that amount only. Timelines vary by insurance plan. For questions about a specific claim, contact our Patient Insurance Support Team at billing@naveris.com or (833) 628-3747.
Can I self-pay for NavDx if I don’t have insurance?
Yes. Patients without insurance or with limited coverage may be eligible for financial assistance through the Naveris Cares™ program. Our Patient Insurance Support Team works directly with uninsured patients to explore available options so that cost is not a barrier to testing. Contact us at billing@naveris.com or (833) 628-3747 to discuss your situation.
Does Medicare cover NavDx for anal cancer?
Yes. Medicare covers serial NavDx testing for surveillance of recurrence in patients with a documented history of HPV+ anal squamous cell carcinoma who currently have no evidence of disease, starting one day following surgery or 7 days following completion of chemotherapy, radiation therapy, and/or immunotherapy. Coverage allows up to 4 tests per year in years 1 through 3, and 2 tests per year in years 4 and 5.