Insurance Coverage & Financial Assistance

Exact Sciences helps patients manage the complexities of health insurance and other payment options for the Oncotype MAPTM Pan-Cancer Tissue test so they can focus on their health.

About GAP

In addition, Exact Sciences created the Genomic Access Program (GAP) to help patients navigate insurance and other payment options for Oncotype diagnostic tests and services. Through GAP, Exact Sciences takes every possible step to ensure testing is affordable, available, and accessible. To learn more about GAP, contact our Customer Service.

Financial Assistance

Exact Sciences also offers financial assistance programs for eligible patients facing financial hardship. Contact Customer Service for more information at 866-ONCOTYPE (866-662-6897).

Medicare Advance Beneficiary Notice (ABN) Forms

Medicare requires that providers give their Medicare patients an Advance Beneficiary Notice (ABN) form before they receive any services that are not considered medically necessary under the Medicare program. This is required because the patient will be responsible for paying for the test if he or she still chooses to receive it.

Situations that Require the Medicare ABN Form

An ABN form is required for the Next Generation Sequencing (NGS) component of the Oncotype MAP test for patients in any of the following situations:
  • The patient does not have recurrent, relapsed, refractory, metastatic, or advanced (stages III or IV) cancer.
  • The patient is not seeking treatment for his or her cancer.
  • The patient has already received NGS testing with Oncotype MAP for the same primary cancer diagnosis.
  • Steps for Providing the Medicare ABN Form

    The following steps must be followed when providing the Medicare ABN form:

    STEP 1

    Confirm that the patient has traditional Medicare coverage. If not, an ABN form may not be required.

    STEP 2

    Provide the patient with the ABN form that includes a description of the Oncotype MAP test’s NGS component, the reason why Medicare may not pay for the test, and an estimated price to be paid by the patient.

    STEP 3

    Ask the patient to review the form and select one (1) of the three (3) options available. Once a selection is made, the patient must sign and date the form.

    STEP 4

    Provide a copy of the signed form to the patient, maintain a copy for your records, and submit a copy along with your order. Submissions can be made by uploading the document to the Physician Portal OR faxing it to 866-444-0640.

    ABN Information Sheet

    Download ABN Information Sheet

    If an ABN is required but not submitted with the order, our billing team will need to contact the patient to obtain the form, which may result in a delay in test results. If you or the patient have questions about the ABN form, please call 866-662-6897 and choose option 2 for Billing.

    The Medicare 14-Day Rule

    Exact Sciences Corporation (Exact) is committed to compliance with all applicable laws, rules and regulations, including billing regulations promulgated by the Centers for Medicare and Medicaid Services (CMS). When a laboratory test such as Exact’s Oncotype MAP Pan-Cancer Tissue Test is ordered for a hospital inpatient within 14 days of the patient’s discharge from the hospital, CMS regulations require Exact to bill the hospital directly for that test. This rule is commonly referred to as the “14-day rule.” The 14-day rule is part of CMS’ Date of Service Regulation (42 C.F.R. Section 414.510). As of January 1, 2018, the 14-day rule does not apply to tests ordered for hospital outpatients, and Exact bills Medicare directly for such tests, regardless of their order date.

    Exact processes test orders as they are received from ordering providers. Clinical judgment should be the determining factor regarding when tests are ordered and Exact does not seek to influence the timing of test orders for any given patient due to billing or other reasons.

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