Insurance Coverage and Paying for the Oncotype DX Test
of patients have $0 financial responsibility*
of Oncotype DX Genomic Prostate Score test patients have a financial responsibility of less than $100**
Exact Sciences is committed to supporting patient access to the Oncotype DX Genomic Prostate Score (GPS) test to help patients in making informed decisions about their treatment. We handle all insurance billing on behalf of patients. If a patient’s insurance denies payment for the Oncotype DX GPS test, Exact Sciences pursues an appeal on the patient’s behalf when appropriate, and if appeal options are available.
The Oncotype DX GPS test is covered by many commercial insurances. A patient’s financial responsibility depends on his specific insurance plan. Plans may include high deductibles (an amount paid by the patient before insurance pays), co-pays (a fixed amount paid per visit or treatment) and non-covered charges. Patients are strongly encouraged to contact their insurer for specific coverage details.
Medicare covers the Oncotype DX GPS test for eligible patients with NCCN® very low-, low-, and intermediate-risk disease. Patients with fee for service (FFS) Medicare will have $0 financial responsibility if they meet coverage requirements. Patients with Medicare Advantage, which is provided by a commercial insurance company, may have different financial responsibility amounts than patients with FFS Medicare.
The Oncotype DX GPS test is reported on claims with the unique proprietary laboratory analysis (PLA) code, 0047U.
Genomic Access Program
Financial assistance is available for eligible patients who are uninsured or concerned about their ability to pay for testing. To ensure that patients can focus on their health, Exact Sciences created the Genomic Access Program (GAP). GAP helps eligible patients navigate insurance and other payment options available for the Oncotype DX GPS test. To learn more, patients can download the GAP Guide or contact our Customer Service team by phone 855-677-6782 (855 6 PROSTATE).
Download the GAP Guide
*This calculation includes patients with Medicare, Medicare Advantage, Medicaid, Managed Medicaid and commercial insurance. Patient cost-sharing amounts, including deductibles and copays will vary by plan and coverage type. Only your patient’s insurer can confirm if and how the Oncotype DX GPS test will be covered.
**This calculation includes patients with Medicare, Medicare Advantage, Medicaid, Managed Medicaid and commercial insurance. Patients with high-deductible plans may receive a bill for most or all the cost of the Oncotype DX GPS test if they have not satisfied their deductible.
Exact Sciences strongly encourages patients to contact their insurer when they have questions about their benefits. Regardless of network status, all commercial insurance coverage is governed by an insurer’s medical policy and patient benefit type