Please note for the COVID-19 Pandemic: All testing can be conducted remotely by having the swab kit sent to you for self administration and sending in the mail. Pre-testing interviews will be conducted via telemedicine sessions.
Genomic tests offer an affordable way for patients and providers to select medication treatments that will work with an individual’s unique biology. While these tests do not diagnose psychiatric illness, they do provide information on metabolic enzymes and genetic markers associated with medication metabolism. If you have never been prescribed psychiatric medications, have had poor treatment response or have had many trials of medication that seem ineffective, genomic testing may help point to alternative medications and other treatments.
Genomic Testing Procedure and Process
The testing consists of a simple cheek swab, meticulous paperwork and urgent delivery of the testing kit. I receive the results within 5 – 7 days through a secure portal where these are then reviewed. A limited summary and interpretation of the therapeutic options are provided to patients and their providers along with the report.
Payments for Genomic Testing:
Several reliable companies are available for these testing services. These companies negotiate all costs with insurance providers, including Medicaid. Other then the co-pay ($300- 340), there is no cost to you for the actual testing amount (which can be charges up to $4500). Following completion of the test, you will receive an EOB (Evidence of Billing) showing the cost, please remember that this is NOT a bill, do NOT pay it. Occasionally, insurance companies follow up with a letter stating that prior authorization is required. Although these letters are directive, this appears to be related to automatic correspondences related to patients receiving oncology testing services and not mental health services.
9/8/21 Statement from Genomind: Updated Blue Cross Billing:
As a valued Genomind customer, I am writing to let you know that Blue Cross Blue Shield of Massachusetts (BCBSMA) will no longer provide coverage for Genomind® Professional PGx Express™, our pharmacogenetic (PGx) assay designed for mental health patients. BCBSMA has stated that it considers use of this assay “investigational for all indications”.
In light of this policy, Genomind will no longer bill BCBSMA for services, and members receiving such tests will be considered “self-pay”. We will bill these individuals directly ahead of running the assay, however, a payment plan is available for individuals who would prefer to pay over time.
In the midst of a global mental health crisis, we believe that BCBSMA’s policy is not in the best interests of its members or BCBSMA itself, given that PGx assay use in psychiatry has been shown to decrease resource utilization1,2. We disagree with BCBSMA’s policy, considering that pharmacogenetic assays such as ours are covered by other large major insurers, including Medicare (in defined circumstances). If you would like to express your opinion on this policy to BCBSMA, please contact them at Provider Services, 1.800.882.2060, or write to them at: Blue Cross Blue Shield of Massachusetts 101 Huntington Ave, Suite 1300 Mail Stop 01/18; Boston, MA 02199-7611
On social media: Tweet @BCBSMA
If your patients wish to appeal to BCBSMA or seek counsel, we can provide assistance.
 Perlis RH, et. al. Pharmacogenetic testing among patients with mood and anxiety disorders is associated with decreased utilization and cost: A propensity-score matched study. Depress Anxiety. 2018;35(10):946-952.
 David V, et.al. An analysis of pharmacogenomic-guided pathways and their effect on medication changes and hospital admissions: a systematic review and meta-analysis. Front Genet. 2021;12:698148.
David S Krause MD |Co-CEO and Chief Medical Officer
Mobile: 215-280-9425 | email@example.com
By law, the genomic testing companies are required to collect a co-pay for the test and will send you a bill directly. The bill will be for the maximum amount ($340). If you meet certain income limitations, you may qualify for a discounted co-pay. You will need to call (or write) to the billing service stated on the invoice to qualify for the lower co-pay. Please do take advantage of the flexible co-pay option if this applies to you!
Please note that if you DO NOT have an insurance that I accept (Blue cross or Cigna), there is an additional charge for the office visit charge (includes interview, test processing, establishing medical necessity for testing and results interpretation). My normal office rate is $250 to $300.