Genetic Counseling


To locate a genetic counselor at Penn Medicine, contact the Cancer Risk Evaluation Center at 215-349-9093. You can also search the National Society of Genetic Counselors’ Find a Genetic Counselor tool or contact your local cancer center. Genetic counselors who perform BRCA testing are often a part of the breast group of academic medical centers or cancer centers. 



BRCA Testing Laboratory Resources
 

  • This list is tailored toward breast/ovarian cancer susceptibility genetic testing and is not intended to reflect all labs that offer genetic testing; information subject to change. Please refer to https://www.cancer.gov/types/breast/hp/breast-ovarian-genetics-pdq for an overview on the genetics of breast and gynecological cancers.
  • Most commercial labs offer single gene, as well as, multigene panel testing options.
  • Cigna has a specific precertification requirement for individuals to receive pre-testing genetic counseling from a genetics provider who meets Cigna standards.
  • Patients with active heme malignancy or allogeneic SCT require fibroblast sample via skin punch and cell culture.
  • Provider responsible for patient informed consent; informed consent documents are available on lab websites. Labs may request provider signature (or e-signature) to indicate informed consent has been obtained.
     

Ambry

Ordering
Accepts insurance: Yes
Ordering: Paper and online portal option (patient
signature needed)
Customer service notifies patient if out of pocket exceeds a threshold: Yes; $100 threshold per TEST, or you may selection notification over $0

Test Options
BRCA AJ Founder 3-site test: Yes
Reflex testing: Same sample, but new
charge
Cascade testing
: Complimentary SSA (single site analysis) on mutations and variants likely pathogenic (VLP) for family members, if performed within 90 days of the proband’s Ambry report and use test code (5555)
Ability to
customize panel: Yes; by gene or preset panels
VUS Reclassification Family Program: Family
Variant of Uncertain Significance Tracking Program at no charge if criteria is met


Insurance-Specific Requirements & Reporting
Medicare, Aetna, Cigna: Must meet insurer’s BRCA testing criteria for insurance coverage
United Health Care (UHC): Must meet UHC BRCA testing criteria; some UHC insurances require provider to submit preauthorization via UHC portal



Color Genomics

Ordering
Accepts insurance: For hereditary cancer test; not for BRCA-only test
Ordering: Paper and online portal option (no patient signature needed)

Test Options
BRCA AJ Founder 3-site test: No
Reflex testing: No
Cascade testing
: Parents, siblings, and adult children of people with mutations for $50
Ability to
customize panel: BRCA only or panel



GeneDX

Ordering
Accepts insurance: Yes
Ordering: Paper and online portal option (patient signature needed)
Customer service notifies patient if out of pocket exceeds a threshold:
Yes

Test Options
BRCA AJ Founder 3-site test: Yes
Reflex testing: Same sample, but new
charge
Cascade testing: No

Ability to customize panel: Yes; by gene or preset panels
VUS Reclassification Family Program: Family Variant of Uncertain Significance Tracking Program at no charge if criteria is met


Insurance-Specific Requirements & Reporting
Medicare, Aetna, Cigna: Must meet insurer’s BRCA testing criteria for insurance coverage
UHC: Must meet UHC BRCA testing criteria; some UHC insurances require provider to submit preauthorization via UHC
portal



Invitae

Ordering
Accepts insurance: Yes
Ordering: Paper and online portal option (no patient signature needed)
Customer service notifies patient if out of pocket exceeds a threshold:
Yes; only if not a covered service or if out-of-network lab; for in-network insurances, patients may be responsible for up to deductible and coinsurance (up to $950, in-network price)

Test Options

BRCA AJ Founder 3-site test: No, full BRCA1/2 only
Reflex testing: At no charge, same sample within 90 days of results report
Cascade testing
: At no charge for first degree relatives of proband with positive result for 90 days after test report date
Ability to
customize panel: Yes; by gene or preset panels
VUS Reclassification Family Program: Family Variant of Uncertain Significance Tracking Program at no charge if criteria is
met

Insurance-Specific Requirements & Reporting
Medicare: If patient meets any national guidelines, there will be no charge to the patient

Aetna, Cigna: Must meet insurer’s BRCA testing criteria for insurance coverage
UHC: Must meet UHC BRCA testing criteria; some UHC insurances require provider to submit preauthorization via UHC portal



Myriad

Ordering
Accepts insurance: Yes
Ordering: Paper and online portal option (patient signature needed
)
Customer service notifies patient if out of pocket exceeds a threshold: Yes; for any amount (>$0) if ordered by GC office, but default (non-GC) is higher

Test Options
BRCA AJ Founder 3-site test: Yes
Reflex testing: No
Cascade testing: No

Ability to customize panel: Yes; by gene or preset panels
VUS Reclassification Family Program: Family Variant of Uncertain Significance Tracking Program at no charge if criteria is
met

Insurance-Specific Requirements & Reporting
Medicare, Aetna, Cigna: Must meet insurer’s BRCA testing criteria for insurance coverage
UHC: Must meet UHC BRCA testing criteria; some UHC insurances require provider to submit preauthorization via UHC portal



Quest Diagnostics

Ordering
Accepts insurance: Yes
Ordering: O
nline portal option (paper requisitions upon request to local Quest representatives)
Customer service notifies patient for most but not all hereditary cancer test panels if out-of-pocket cost exceeds $100

Test Options
BRCA AJ Founder 3-site test: Yes
Reflex testing:
No, but Quest has a test order that runs AJ Founder Mutation testing as first line test and only if negative, “reflexes” to comprehensive testing of BRCA1/2
Cascade testing: No

Ability to customize panel: No
VUS Reclassification Family Program: Quest Insight Variant Classification Program available to family members if criteria is met


Insurance-Specific Requirements & Reporting
Medicare, Aetna, Cigna: Must meet insurer’s BRCA testing criteria for insurance coverage
United Health Care (UHC): Must meet UHC BRCA testing criteria; some UHC insurances require provider to submit preauthorization via UHC portal



23andMe

Ordering
Accepts insurance: No
Ordering: Direct to consumer

Test Options
BRCA AJ Founder 3-site test: Yes, but not intended for medical use (chain of custody sample issue)



    Genetic Testing in Primary Care Practice: Where We Are and Where We Are Headed


    In this informative webinar for primary care providers, Susan Domchek, MD, reviews the nuances, controversies, and potential advantages and detriments of genetic testing for breast cancer susceptibility. Executive Director of the Basser Center and contributor to more than 200 articles on the genetics of breast cancer, Dr. Domchek offers an update on genetic testing strategies for breast and ovarian cancer risk; describes the testing and disclosure procedures at the Basser Center; considers  the importance of Ashkenazi Jewish ancestry in cancer genetics; and discusses issues related to decreasing the barriers to population screening for BRCA1/2 mutations.

    View the webinar now.