Prior Authorization

On behalf of our clients, Mayo Clinic Laboratories will seek insurance authorization for eligible tests and file an insurance claim upon final result.

Prior authorization services are available for a select number of tests, listed in the following table. On completion of prior authorization services, Mayo Clinic Laboratories will bill the insurance carrier and accept the amount of coverage assigned.

In some cases, your patient may be responsible for paying charges for services deemed not medically necessary by the insurance carrier.

Specimen Handling

When prior authorization services are requested, Mayo Clinic Laboratories will extract and store the DNA from the specimen on arrival and verify patient insurance coverage prior to sample analysis.

The following billing guidelines apply:

• If the expected patient out-of-pocket expense is $200 or less after prior authorization services, Mayo Clinic Laboratories will proceed with the testing and file an insurance claim upon final result.
• If the expected patient out-of-pocket expense is greater than $200, Mayo Clinic Laboratories will seek approval from the contact listed on the Prior Authorization documents before proceeding with testing.

Ordering Instructions

If you are not requesting that Mayo Clinic Laboratories perform prior authorization accompanied by third party billing services, no additional steps are required.

If you would like to order one of the eligible tests and request that Mayo Clinic Laboratories perform prior authorization accompanied by third party billing services, follow these steps:

1. Determine the appropriate test to order, and click the corresponding Test ID in the following table.
2. In the Special Instructions and Forms section of the test, complete the Prior Authorization Ordering Instructions.
3. Send the prior authorization documents with your specimens and test requisition or electronic order to Mayo Clinic Laboratories via overnight courier. Specimens received without the prior authorization documents will be processed immediately and the order will be billed to your facility.

Eligible tests are listed in the following table:

Updated December 17, 2020

For assistance or questions, contact the Billing office.