Connecting Genetic Testing to Clinical Care
Cohesion Phenomics provides cardiovascular genetic testing for the adult population and clinical molecular genetics expertise across inherited cardiovascular conditions. Genetic findings are considered within the patient's phenotype, clinical history, and family history to support meaningful interpretation and integration into cardiovascular care.
Market Access & Reimbursement
Access to genetic testing depends not only on clinical appropriateness, but also on navigating payer coverage, medical necessity requirements, prior authorization, and reimbursement.
Cohesion Phenomics brings experience in the coverage and reimbursement landscape surrounding genetic testing to help address barriers that can delay or prevent access.
Market access considerations can be incorporated throughout the testing process, including:
- Benefits and eligibility
- Coverage assessment
- Prior authorization
- Medical necessity requirements
- Documentation
- Payer communication
- Reimbursement considerations
Insurance, Prior Authorization & Billing
Clear, transparent workflows to support patients and providers through insurance verification, coverage requirements, and claims.
Prior Authorization
When required by the patient's health plan, Cohesion Phenomics coordinates prior authorization (PA) before genetic testing is initiated. Prior authorization may be submitted directly to the patient's insurance plan or to the laboratory benefit manager designated by the plan.
Testing will proceed after the required authorization has been obtained and coverage requirements have been met. Patients and referring providers may receive documentation of the authorization determination directly from the insurance plan.
If prior authorization is denied, Cohesion Phenomics can assist with appropriate appeals when additional clinical information or documentation may support reconsideration.
Claims & Billing
Cohesion Phenomics bills genetic testing services using applicable CPT Tier 2 Molecular Pathology codes and submits claims directly to participating insurance plans. When an applicable CPT code is not available for a genetic testing service, Cohesion Phenomics does not submit the service to the patient’s insurance plan for reimbursement. Testing may be available on a self-pay basis. In some circumstances, assistance from the patient or referring provider may be requested to resolve claims that remain unpaid or require additional information.
Prior authorization does not guarantee payment. Final coverage and payment are determined by the patient's health plan in accordance with the terms of the patient's benefits and applicable coverage policies.
Patients are responsible for applicable deductibles, copayments, coinsurance, and other out-of-pocket costs as determined by their individual health plan.
Participating Insurance Plans
Cohesion Phenomics is currently in network with:
Cohesion Phenomics does not currently accept Medicare or Medicaid.
Insurance participation and coverage may vary by plan and are subject to change. Please contact the laboratory for current participation and coverage information.
Specimen Acceptance
Cohesion Phenomics currently accepts patient specimens collected within North Carolina. Specimens collected outside North Carolina cannot be accepted for testing at this time.
Please contact the laboratory with questions regarding insurance coverage, prior authorization, billing, or specimen eligibility.
Provider & Clinic Resources
Requisitions & Forms
Access laboratory requisitions, patient registration forms, informed consent forms, insurance authorization documents, and other required paperwork.
Specimen & Shipping
Review specimen requirements, collection and labeling instructions, packaging requirements, and shipping information.
Genetic Testing Inquiry
Connect directly with our clinical molecular genetics team regarding test selection, eligibility, or case review.