Medicare Coverage For Diagnostic Tests

The list below contains Metametrix tests that Medicare deems to be diagnostic. Other testing is not considered diagnostic and experimental or educational in nature. Meaning, these tests could potentially be used by your physician to aid in diagnosing your condition, and thus may be covered. Medicare is NOT expected to cover tests that do not appear on this list. To have Metametrix file a Medicare claim for any of the following tests, we will need a valid copy of your insurance card and a signed, completed Advanced Beneficiary Notice (ABN) in order to proceed. When processing potentially covered tests, NO PAYMENT IS DUE at the time of filing.

GI Effects (used to identify gastrointestinal disorders)

• In order to file a Medicare claim on your behalf, we will need to have a signed, completed Advanced Beneficiary Notice (ABN). Specimen submissions without a signed, completed ABN will delay the release of test results.
• For tests that Medicare deems to be medically unnecessary, we recommend our Patient Prepay option. You may still choose to have Metametrix file a claim on your behalf and pay 20% of the test’s list price. However, Medicare is not expected to approve your claim and you willed be billed for any remaining balance. For all payment options on non-covered tests, please contact the Metametrix Billing department.
• Unless otherwise instructed, we will process tests for patients 65 and older through Medicare. However, we cannot file a claim without your complete insurance information AND a signed and completed ABN.
• Metametrix can refile Medicare claims that are denied for missing and/or invalid information.
• If Medicare denies your claim, you will be responsible for the remaining balance.

What To Do Now

• Once you receive your test kit, complete and sign the Test Requisition Form (TRF) found within the kit’s contents.
• Sign and complete your Advanced Beneficiary Notice (ABN). Your claim will not be processed without this form.
• Submit the following items according to the kit instructions:
  • Completed and signed TRF
  • Completed and signed ABN
  • Copy of your insurance card
  • Your collected specimen
• Once we receive each completed and properly submitted item, Metametrix will file a claim on your behalf.
• You will be billed for any test(s) and/or remaining balance that Medicare classifies as your responsibility.

• Once you receive your test kit, complete and sign the Test Requisition Form (TRF) found within the kit’s contents.
• Submit the following items according to the kit instructions:
  • Completed and signed TRF
  • Completed and signed ABN (optional)
  • Copy of your insurance card
  • Your payment - full Patient Prepay price (recommended) OR 20% of the test’s list price
• Your collected specimen per the instructions provided in your test kit
• For tests that Medicare deems to be medically unnecessary, we recommend our Patient Prepay option. You may still choose to have Metametrix file a claim on your behalf and pay 20% of the test’s list price. However, Medicare is not expected to approve your claim and you will be billed for any remaining balance. For all payment options on non-covered tests, please contact our Billing department.

Frequently Asked Questions

1. How will I know if my test is covered?
Answer: Medicare is the best source for details about your coverage.  Please contact Medicare at 1.800.MEDICARE (1.800.633.4227).


2. Where can I find an Advanced Beneficiary Notice?
Answer: If an ABN was not included with your test kit, a downloadable version is available on our ABN page. On the ABN page, please find the name(s) of the test(s) ordered by your clinician and download the applicable form(s). Then review, sign and include it with your specimen submission. You may also contact the Metametrix Billing department.


3. How do I know if I’m selecting the right payment option?
Answer: Now that you know Metametrix has expanded our payment options in a way that may benefit you, instructions on how to proceed are located in our “What to Do Now” section (above). Please contact our Billing department if you are still unsure about the right option for you.


4. How will I know the cost of my test?
Answer: Your doctor should be able to discuss test pricing with you. If not, feel free to contact the Metametrix Billing department.


5. If my claim is denied, how will I know AND what should I do next?
Answer: If your claim is denied, Medicare will notify you with an explanation of your benefits and you will be billed for the balance remaining on your account. In the event that this happens, please contact the Metametrix Billing department.


6. Can you tell me if my claim will be approved/denied?
Answer: No, only Medicare can make the determination of whether your claim is approved or denied.


7. Are there other reasons besides an invalid diagnosis code that may cause my claim to be denied?
Answer: Yes, claims that have missing information OR that are submitted for tests that Medicare deems to be medically unnecessary in diagnosing your condition will be denied.


8. What forms of payment may I use to pay my remaining balance?
Answer: Acceptable payment methods are Visa, Mastercard, American Express, Discover, money order, or check, payable to Metametrix.  Canada and international residents may pay by credit card or wire transfer only.