Advanced Beneficiary Notice

To have Metametrix file a Medicare claim for any test, we will need a valid copy of your insurance card AND signed, completed Advanced Beneficiary Notice (ABN) in order to proceed. Please click the name(s) of all applicable tests to download and complete the corresponding ABN.

• AA/EPA Ratio - 0240
• ADMA - 0014
• Adrenal Stress - 0243
• Adrenal Stress Plus - 0043
• Allergix^SM IgG4 Food Antibodies – 90 - 0075
• Allergix^SM IgG4 Food Antibodies – 30 - 0076
• Allergix^SM IgE - 30 - 0077/0071 (NY)
• Allergix^SM IgE Inhalant Antibodies - 7200
• Allergix^SM IgG4 & IgE - 0270/0271 (NY)
• Allergix^SM IgG4 Food Antibodies & Celiac - 0278
• Amino Acid Profile - 11 - 0013
• Amino Acid Profile - 20 - 0113
• Amino Acid Profile - 20 - 0011/0311 (NY)
• Amino Acid Profile - 40 - 0010/0310 (NY)
• Amino Acid Profile - Urine - 0012/0312 (NY)
• Bisphenol A (BPA) Profile - 0764
• Bone Resorption - Deoxypyridinoline - 0018
• BPA, Phthalates & Parabens, Organophosphates Combo Profile - 1763
• BPA and Phthalates & Parabens Combo Profile - 1764
• Cardiovascular Health Profile - 0161/0361 (NY)
• Cardio/ION^SM Profile - 0290/0390 (NY)
• Celiac Profile - 0078
• Chlorinated Pesticides Profile - 0760
• Chlorinated Pesticides and PCBs Combo Profile - 1760
• Chlorinated Pesticides, PCBs, Volatile Solvents Combo Profile - 1761
• Coenzyme Q10 - 0034
• Coenzyme Q10 Plus Vitamins - 0033
• DNA/Oxidative Stress Marker - 0087
• Elements - Nutrients and Toxic Elements - Hair - 0020
• Elements - Nutrients and Toxic Elements - Whole Blood - 0022
• Elements - Nutrients and Toxic Elements (NY) - Whole Blood - 0037
• Elements - Toxic Metals - 0026
• Elements - Nutrients and Toxic Elements - 6-8 Hr - 0052
• Elements - Nutrients and Toxic Elements (NY) - 6-8 Hr - 0055
• Elements - Toxic Metals - 6-8 Hr - 0152
• Elements - Toxic Metals (NY) - 6-8 Hr - 0155
• Elements - Nutrient and Toxic Elements - 24 Hr - 0058
• Elements - Nutrient and Toxic Elements (NY) - 24 Hr - 0059
• Elements - Toxic Metals - 24 Hr - 0158
• Elements - Toxic Metals (NY) - 24 Hr -0159
• Estronex^SM Profile - 0142
• Estronex^SM Profile with Bone Resorption - 0145
• Fatty Acids Profile (Plasma) - 0040
• Fatty Acids Profile (Erythrocytes) - 0041
• Fatty Acid Profile - 0241
• Fat-Soluble Vitamins - 0036
• GI EffectsSM Profile - 2100
• Gliadin Sensitivity Profile - 0072
• Homocysteine - 0093
• IGF-1 - 0045
• Insulin - 0044
• ION^SM Profile - 0090/0190 (NY)
• ION^SM Profile with Amino Acids - 0490/0590 (NY)
• Lipid Peroxides (TBARS) - 0051
• Male Hormones Profile - 0140
• Metabolic Syndrome Profile - 0146
• Neopterin/Biopterin Profile - 0088
• Organix^SM Comprehensive Profile - 0091/0391 (NY)
• Organix^SM Basic Profile - 0291/3291 (NY)
• Organix^SM Dysbiosis Profile - 0097/0397 (NY)
• Organophosphates Profile - 0763
• PCBs Profile - 0761
• Porphyrins Profile - 0060
• Phthalates & Parabens Profile - 0740
• TRIAD^SM - 0400
• TRIAD^SM Bloodspot - 0410
• Vitamin D Assay - 0032
• Vitamin K Assay - 0031
• Volatile Solvents Profile - 0762
• Women's Health Profile - 4146