The following information is provided to help families maximize their insurance benefits for the Cunningham Panel™ of tests. The Cunningham Panel™ includes a series of 5 clinical assays (tests). Four of these tests include enzyme-linked immunosorbent assays (ELISA) to measure autoantibody titers directed against antigens present in the brain. These antigens include anti-dopamine receptor D1, anti-dopamine receptor D2L, anti-lysoganglioside GM1 and anti-tubulin.
The fifth test measures the level of activity of calcium/calmodulin-dependent protein kinase (CaMKII) to test for signaling antibodies in the brain. In the case of each analysis, the test results from the assays are compared with normal control values; the normal control values are obtained from non-PANDAS subjects of similar ages using the same assays.
The panel of 5 tests requires approximately 3-4 weeks to process, so please allow that amount of time to have your specimen processed and results returned to your physician. Our intent is to make this test as cost-effective as possible. The following information may be helpful to your insurance provider to determine your insurance benefits for the Cunningham Panel™.
What is the cost of the Cunningham Panel™ of Tests?
The full price of the 5-test Cunningham Panel™ is $925.
Who files insurance?
If you have an employer sponsored or private medical insurance plan, Moleculera Labs can file your insurance on your behalf. If you would like us to file your insurance, we require a $425 deposit when the test is ordered. If your insurance provider pays the full $925, we will refund your entire deposit of $425. If your insurance pays more than $500 of the testing costs, we will reimburse any amount over $500, up to your full $425 deposit. If your insurance does not pay, or pays less than the difference between your deposit and the cost, we will send you a billing statement for the difference.
Insurance Coverage Checklist
At this time, Moleculera Labs is unable to perform precertification, preauthorization, or predetermination of benefits on behalf of patients for our testing. However, by utilizing the step-by-step process on the Insurance Coverage Checklist (link above) to start a discussion with your insurance carrier, you can usually get some idea of the potential for coverage. It is not possible to guarantee that any insurance company will cover The Cunningham Panel™ of Tests, regardless of which provider orders it, or whether the provider is, or is not, in the insurance company’s provider network.
If you have a government sponsored medical insurance plan such as Medicare, Medicaid, Tricare, etc., we are unable to file claims on your behalf. Since we are considered an out-of-network provider for government sponsored plans, the patient/member will have to file the claim. Generally, we require the full payment of $925 when the test is ordered.
If you prefer to file the insurance claim yourself, you will need to pay the full price of $925 when the test is ordered.
If you need an itemized statement in order to file your claim, please contact us.
If you are unable to pay the deposit or full price of the panel upfront or need to make payment arrangements, please contact our office and we will work with you on a case-by-case basis to find a payment arrangement that works for your family.
When is insurance filed?
Insurance is filed once the test report has been released. The date of service used to file the insurance is the specimen collection date (the date the specimen was drawn).
Because we are the only laboratory that provides this test panel, Moleculera Labs is considered an “out-of-network” provider for all insurance companies. Actions that may help with your insurance claim include:
Some insurance plans will consider the panel as in-network if an in-network physician orders the test. We recommend that you contact your insurance company and inquire about this prior to testing.
Because we are out-of-network, we encourage patients to contact their insurance company prior to testing to request a precertification or an out-of-network waiver for the Cunningham Panel™ of Tests.
To help support a pre-certification, an out-of-network claim, or filing of your own claim, we have some resources available to you in the Parent/Patient Resources section of our website.
- Moleculera Labs is the only lab that performs this panel. As such, we encourage patients to ask their insurance company to consider Moleculera Labs as in-network. To help support this request, we have a Sole Provider Letter available on our website which can be provided to your insurance company.
- Ask your physician to provide a Letter of Medical Necessity. A sample Letter of Medical Necessity can be found in the Physician Resources section of this website.
What are CPT codes and which ones are used for the Cunningham Panel™?
CPT codes are procedure codes that describe the medical services performed for the test.
- 83520×4 – Immunoassay for Analyte
- 88230 – Tissue culture for non-neoplastic disorders; lymphocyte
- 86352 – Cellular function assay involving stimulation and detection of biomarker
What are ICD-10 codes?
ICD-10 codes are diagnosis codes that describe the clinical reason for ordering the test. These codes are used when filing an insurance claim to help the carrier determine the medical necessity of the test. Your physician provides these codes when they order the Cunningham Panel™.
If you are requesting a pre-authorization from your insurance carrier, they may request these codes. If your physician has entered a test requisition in our online portal, then we can provide them to you. If your physician has not entered a test requisition yet, then you will need to contact your physician to get the appropriate code(s). Moleculera Labs is committed to helping patients in need of testing.
Please feel free to contact our office at 405-239-5250 or email our Billing Department at email@example.com with any questions or concerns.