Transparent billing

Invitae believes in responsible testing that is based on established medical guidelines, and we aim to be completely transparent with our pricing so that patients, clinicians, and payers know the cost of the test. Invitae offers genetic analysis to identify the cause of a disease affecting an individual or a family. Our pricing is per clinical area.

Learn more about these options using the tabs below:

If preferred, patients in the US and Canada have the option to pay $475 per clinical area, upfront and in full.

  • Patient prepay orders must be placed online, including the requisition from the clinician.
  • This is available as a prepaid option only and does not allow Invitae to submit to insurance.
  • The patient agrees to register online and set their contact preferences.
  • Patient assistance programs are not available for patient prepay option.

To take advantage of the $475 price, simply place the order online, selecting the “Patient Pay” option during the billing portion of the online requisition process. You will be asked to enter your patient’s email address. We will follow up with your patient directly to have them sign up for an account and pay online by credit card. Visa, MasterCard, Discover, and JCB cards are all accepted. These steps must be followed before the report will be released.

It is important to note that for patient pay pricing, we require patients to go through their healthcare provider to order our tests. Healthcare professionals are fundamental to ordering the right test for the right patient and in interpreting genetic information. Invitae believes that patients should own and control their own genetic information, thus we do not require our patients to sign their data away; we allow them to opt out and still receive the test. While genetic information is more valuable when shared, patients own their data and should decide what they want to do with it.

  • For institutions and distributors under contract with Invitae and payers who contract with Invitae under certain terms, the price per clinical area is $950.
  • For non-contracted institutions, the price per clinical area is $1,500.

To choose institutional billing, select the "Institutional Billing" option during the billing portion of the online requisition process. We will work with your institution to set up a contract if one is not already in place, and we encourage referring institutions (i.e., clinics, hospitals, labs, and private practices) to set up contracts with us in advance.

  • For payers who bring Invitae in-network under certain terms, the price per clinical area is $950.
  • For third-party payers for which Invitae is out-of-network, the price per clinical area is $1,500.

Invitae can bill insurance carriers directly. (This option does not apply to the $475 patient-pay price.) Simply select the "Insurance Billing" option during the billing portion of the online requisition process. Patients won’t need to contact their insurance company to find out if testing is covered or to obtain reimbursement; Invitae will contact the insurance company directly to coordinate coverage and payment. Patients may receive an explanation of benefits (EOB) from their insurance company in the mail: This is not a bill. Invitae will also receive this EOB and will handle any appeals processes.

Please be prepared to provide the following information if you wish to bill insurance for an order:

  • The patient's first and last name, phone number, and mailing address
  • A copy (front and back) of the patient's insurance card
  • Relevant ICD10 codes
  • A letter of medical necessity

Regardless of whether a patient is in-network or out-of-network, Invitae's goal is that a patient will never be surprised by an out-of-pocket balance. To help provide patients with accurate information regarding out-of-pocket insurance requirements, Invitae may conduct a benefits investigation. Where Invitae's benefits investigation discloses a plan that requires a patient out-of-pocket in excess of $100, Invitae will notify the patient. The patient may then opt to cancel the test and avoid all charges.

Medicare can be used to pay for an Invitae test when specific criteria are met. Invitae's criteria align with clinical practice guidelines from organizations including the National Comprehensive Cancer Network® (NCCN).

The following forms must be included with your Medicare order:

  • The appropriate Invitae Medicare ordering form, available for oncology here, Lynch syndrome here, and cardiology here.
  • A letter of medical necessity, available here
  • Any applicable medical records

We also strongly encourage the inclusion of:

  • A detailed family history or pedigree
  • A signed informed consent form, available here (please ensure the informed consent form is dated on or before the date of blood draw)

If your patient has Medicare as well as commercial insurance, the Medicare forms are still required. Invitae will pursue claims with either the commercial insurance carrier or Medicare as needed.

Invitae is committed to making genetic testing affordable and accessible by removing financial and logistical barriers. Our Patient Assistance Program (PAP) provides:

  • a partial or total reduction in out-of-pocket costs for patients with commercial insurance who meet certain financial and clinical criteria
  • a complete elimination of out-of-pocket costs for uninsured patients and patients insured by Medicaid (state or managed) who meet certain financial and clinical criteria

The Patient Assistance Program is available to patients in the US who both meet relevant clinical criteria for the ordered test and have income at or below four times the US poverty guidelines.

In 2016, this means that an individual who earns less than $48,000 per year would qualify for the program. The qualifying income level increases by $16,000 for each additional member of the household.

Qualifying income levels in 2016

Individual

Less than $48,000

Family of 2

Less than $64,000

Family of 3

Less than $80,000

Family of 4

Less than $96,000

Family of 5

Less than $112,000

 

Uninsured patients: For patients who meet this income standard and are uninsured, Invitae will waive fees for the patient’s test under the program.

Patients with Medicaid: For patients who qualify for the program and are uninsured, Invitae will waive fees for the patient’s test under the program. In addition, Invitae will require the patient’s physician to certify that Medicaid will not be billed for the test.

Patients with commercial insurance: For patients who qualify for the program and are insured with commercial insurance (not Medicare, Medicaid, or similar government insurance programs, Invitae will discount tests on a sliding scale according to income. Patients below the national poverty line (in 2016, approximately $12,000 for an individual plus $4,000 per additional family member) will have balances waived entirely. Patients between the national poverty line and four times the national poverty line will receive discounts on a sliding scale.

Documentation: We ask for proof of income documentation in the form of an IRS Form 1040. If a 1040 is not available, please contact Client Services to discuss other options. Applications are available on the Forms page.

CPT Codes
If you are ordering a test that includes BRCA1 or BRCA2, the CPT code is 81211. For all other tests, the CPT code to use is 81479 - unlisted molecular pathology procedure.
ICD-10 Codes
Invitae defers to the ordering healthcare provider to select the appropriate diagnosis codes for each order. To identify the appropriate ICD-10 code(s), we recommend reading through the resources posted on the Centers for Medicare & Medicaid Services (CMS) website. In addition, many helpful third-party tools exist to translate ICD-9 codes to ICD-10 codes—these can be a good starting point to learn the new codes, although providers should use their best medical judgement as there often are not one-to-one mappings. If you need help, please contact client services.
Invitae's NCBI number
1316206220
More information
FAQ

More questions about our billing options? Visit our FAQ page.