Billing

The following requirements must be met in order to initiate testing:

• Financial responsibility is established
• Required forms are completed and received
• Billing issues are resolved.

We are not able to bill insurance plans with which we are not contracted to provide laboratory services, even if the plan authorizes testing.

Note About CPT Codes - as many of our tests for rare diseases are using the unlisted code (81479), we anticipate an increase in denials of coverage.  Verification of coverage of the test codes is required, and patients should be informed of the possibility of insurance denials.

CPT Code List

Billing options:

• Institutional Billing
• Patient Self-Pay
• Contract Managed Care/Insurance
• Maryland Medicaid
• Medicare

Institutional Billing 

If the institutional billing option is selected, an invoice will be sent to the referrer’s organization and address unless otherwise specified in the billing section or on a separate sheet attached to the requisition form. If an organizational credit card will be used, please complete the credit card authorization form.

Patient Self-Pay

• Billing Consent Required for all self-pay patients
• Credit Card Authorization Additional requirement if paying with credit card

If the patient is paying out of pocket, we require a personal check, cashier's check or money order (made out to Johns Hopkins University) or credit card information.  We are unable to directly bill patients for services.

If requested, we will mail the patient a receipt that may be submitted to the insurer to request reimbursement.  Please indicate this request on the requisition form and provide the patient's complete mailing address.

Contract Managed Care/Insurance

We are contracted with many national health plans, although we are not contracted with HMO plans or many smaller regional plans.

We strongly recommend contacting our billing coordinator prior to submitting a sample to arrange insurance billing.  Faxing the patient's Insurance Card ahead of time will allow us to verify the contract status.

Required Documents

• Copy of patient's insurance card, front and back
•  Letter of medical necessity from referring physician
  • See a sample letter
  • Checklist for creating letter of medical necessity
• Billing Consent
• Authorization letter (if required by the insurance plan), including the authorization number and CPT codes authorized; or if no authorization is necessary, note the name and extension of the plan employee who provided this information. 

Maryland Medicaid

Maryland Medicaid Billing includes Medicaid managed care providers in Maryland. We are not able to bill any Medicaid program outside of Maryland.

Required Documents

• Copy of patient's insurance card, front and back
•  Letter of medical necessity from referring physician
  • See a sample letter
  • Checklist for creating letter of medical necessity
• Billing Consent
• Copy of driver's license or photo ID (required for 18 and older only)
• Physician referral or prescription for testing

Medicare

Required Documents

• Copy of patient's insurance card, front and back
•  Letter of medical necessity from referring physician
  • See a sample letter
  • Checklist for creating letter of medical necessity
• Billing Consent
• Copy of driver's license or photo ID (required for 18 and older only)
• Physician referral or prescription for testing
• Signed Medicare Advanced Beneficiary Notice (see instructions for completing Advanced Beneficiary Notice)