Insurance Cunningham PanelThe following information is provided to help families determine 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 2-3 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. The full amount is ultimately the responsibility of the patient/responsible party.

Moleculera is the sole testing laboratory for the Cunningham Panel™.  We are a very small organization but are committed to doing everything we can to ensure that all those truly in need can receive testing.  At this time, we do not participate in any insurance or government sponsored plans.  A deposit or full payment is due when the panel is ordered (see details below).    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.

Patients covered by commercial insurance (through an employer group or individually purchased plan):

Moleculera does not participate in any insurance plans and is considered an “out-of-network” provider for all insurance companies.  “Out-of-network” means that we do not accept insurance discounts or allowables.  The full cost of $925 will ultimately be the patient’s/responsible party’s responsibility regardless of how insurance may process the claim. It is your sole responsibility as a patient/responsible party to obtain all necessary insurance authorizations and know in advance what your plan will or will not cover prior to testing.

Moleculera Labs can file a claim on your behalf.  If you would like us to file your insurance, we require a $425 deposit when the panel is ordered.  If there is a balance due after your claim is processed, you will receive a billing statement for the amount due.  The balance due is responsibility of the patient/responsible party.  If there is a credit due after your claim is processed, we will issue a refund to the responsible party.

If you prefer to file the insurance claim yourself, payment of $925 is due when the panel is ordered.

Patients who are covered by government sponsored insurance such as Medicaid, Medicare, TRICARE, etc.:

Moleculera does not participate in government sponsored plans, including those administered by a commercial insurance company such as Medicare Advantage Plans.  Patients covered by government sponsored plans must agree not to submit a claim for reimbursement from those entities.  Payment of $925 is due when the panel is ordered.

Insurance Coverage Checklist

Download 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.

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 collected).

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 which can be provided to your insurance company. Download Sole Provider Letter.
  • 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 or downloaded here. Download Sample Letter of Medical Necessity.

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.

Payment Information

A deposit payment of $425 or full payment of $925 is due at the time your practitioner places your order. See details above to determine which amount applies to you.

If your practitioner has already placed an order, you should have received an email link where you can enter your deposit or full payment and your insurance information. If for some reason you did not receive the email, click the “MAKE DEPOSIT PAYMENT” button to enter that information.
MAKE DEPOSIT PAYMENT

If your testing is completed and you have received a bill from Moleculera Labs, you can make an online payment by using our Online Bill Pay system. Click the “PAY MY BILL” button to pay your invoice online.
PAY MY BILL

Cancellation and Refund Policy

Cancellation of testing services must be made within 48 hours of physician order.  To cancel testing services, please call us at (405) 239-5250. A full refund will be provided on testing services cancelled within 48 hours of physician order.  Refunds will be provided as a credit to the credit card used at the time of purchase within five (5) business days of the notification of cancellation.

Questions? Concerns?

Please feel free to contact our office at 405-239-5250  or email our Billing Department at billing@moleculera.com with any questions or concerns.