COST AND INSURANCE COVERAGE FOR SIBO TEST – SEATTLE, WA
INSURANCE COVERAGE
The Center for SIBO Testing is contracted with the following health insurance carriers: Premera, Regence, Blue Cross Blue Shield, Lifewise, First Choice Health, Providence Health Plan, Kaiser Permanente (through First Choice), Bridgespan, Asuris, and Cigna. While all of these carriers provide coverage for SIBO testing, coverage and benefits are specific to the patient’s individual health plan. Please note that The Center for SIBO Testing is not contracted with Medicare, Medicaid, Tricare, Aetna, or United Healthcare. Also, Molina and Ambetter Coordinated Care consider this test experimental and therefore do not provide coverage for this test. Please note that Kaiser Permanente covers this test only if ordered by a gastroenterologist.
WHAT TO ASK YOUR INSURANCE CARRIER
Before ordering a SIBO test, please call your insurance company and ask whether a breath hydrogen or methane test is covered under your insurance plan. By providing the following specific information, your insurance carrier should be able to tell you unequivocally what your coverage for this test will be:
- Procedure code (also known as CPT code): 91065 – breath hydrogen or methane test
- Billing provider: Dr. Rian Shah
- Billing provider’s NPI: 1285948695
- Rendering facility: Cascade Integrative Medicine (which is the parent company of the Center for SIBO Testing)
- Tax identification number: 46-5114957
- Diagnosis code(s): these are supplied by your provider.
**Note that the customer service agent from your insurance plan will not be able to give you an accurate determination of your coverage unless ALL of the above items are provided.**
Also, be sure to ask whether coverage for hydrogen and methane breath testing requires preauthorization. If so, your provider should submit a request for preauthorization to your insurance carrier BEFORE ordering this test for you.
SIBO TEST COST
There are two fees associated with the SIBO test:
- Shipping fee: $35. This charge is non-refundable and is not covered by insurance
- Laboratory fee: $225. This charge is billable to insurance.
Shipping Fee
The shipping fee is non-refundable and must be paid prior to shipment of your test kit. This is not covered by insurance, and therefore, not billable to your insurance plan. However, you may use your health savings or flexible spending account to pay for this.
Laboratory Fee
As long as we are contracted with your insurance carrier, we will submit a claim to your insurance carrier for the laboratory charges. If your health insurance policy is with one of our in-network insurance carriers, most, if not all, of the laboratory fees may be covered. If the laboratory fees are not covered, or are partially covered, by your insurance policy, or if you elect not to have your claim submitted to your insurance carrier, you will be responsible for no more than $225.00 for all laboratory charges.