KENOSHA CHARGE 10006884 KARIUS TEST NGS Insurance and Self Pay Discounts 310 0152U $4,350.00

The Karius Test (CPT 0152U) is a next-generation sequencing (NGS) blood test designed to detect pathogens by identifying microbial cell-free DNA, assisting in rapid diagnosis of infections. The fee typically covers laboratory processing, sequencing, analysis, and reporting. Costs can vary widely depending on insurance, with self-pay and various insurer-negotiated rates available. To avoid unexpected expenses, patients should request an itemized cost estimate from their provider and verify coverage details with their insurer before proceeding.

Cost Breakdown

  • Standard Charge (Hospital): $4,350.00
  • Self-Pay Discounted Rate: $2,396.62
  • Insurance Payment Range: $2,175.00 – $3,697.50
  • Sample Insurance Rates:
    • Aetna: $1,850.74 – $3,598.92
    • Anthem: $1,993.59 – $3,697.50
    • Cigna: $2,566.13 – $3,679.75
    • UHC (UnitedHealthcare): $2,083.25 – $3,680.12
    • Humana: $2,390.64 – $3,651.36
    • Quartz: $1,942.25 – $2,137.62
    • WPS: $2,276.79 – $2,396.62

Associated Costs

  • Pre-test clinical evaluation (office visit fees)
  • Phlebotomy/blood draw charges (if not included)
  • Follow-up consultations to discuss results
  • Additional confirmatory or follow-up tests if required

Insurance & Payment Advice

  • Contact your insurance provider to confirm test coverage, applicable deductibles, and copayments.
  • Request the test’s CPT code (0152U) and share it with your insurer for preauthorization if needed.
  • Ask for an itemized bill to review all charges.
  • Inquire about financial assistance or payment plans if paying out-of-pocket.
  • Verify if the provider is in-network to maximize insurance benefits.

Side-Effect Considerations

  • The Karius Test is a blood draw; typical risks include minor pain, bruising, or dizziness at the puncture site.
  • No known systemic side effects from the test itself.

Recovery Tips

  • Apply pressure and a bandage to the blood draw site to minimize bruising.
  • Stay hydrated and eat a small snack after the blood draw if you feel lightheaded.
  • Follow up with your provider to discuss the results and any recommended next steps.

Frequently Asked Questions

  • What is the Karius Test used for?
    The Karius Test helps detect infections by identifying microbial DNA in your blood, aiding in rapid diagnosis when the source of infection is unclear.
  • Is the Karius Test covered by insurance?
    Coverage depends on your insurance plan. Contact your insurer and provide the CPT code 0152U to confirm if the test is covered and whether preauthorization is needed.
  • How much does the Karius Test cost without insurance?
    The self-pay rate is approximately $2,396.62, but you should confirm the latest rates and available discounts with your provider.
  • What does the test fee include?
    The fee generally covers laboratory analysis, sequencing, and result reporting, but may not include blood draw or physician consultation fees.
  • Can I get a payment plan for the test?
    Many providers offer payment plans or financial assistance for self-pay patients. Ask about available options before your test.
  • How long does it take to get results?
    Results are typically available within a few days, though timing can vary by provider and laboratory workflow.
  • Are there risks or side effects from the Karius Test?
    The main risk is minor discomfort or bruising from the blood draw; the test itself does not pose additional risks.
  • Will I need follow-up tests?
    Depending on the results, your provider may recommend follow-up tests or additional evaluations to confirm a diagnosis or guide treatment.
  • What information should I give my insurer to check coverage?
    Provide the test name (Karius Test), CPT code 0152U, and your provider’s details to your insurance representative for the most accurate coverage information.
  • Is preauthorization required?
    Some insurance plans require preauthorization for advanced lab tests. Check with your insurer to avoid denied claims or unexpected costs.
  • Can my results affect my insurance coverage?
    Laboratory results are protected by privacy laws. However, discuss any concerns about future coverage with your insurer or provider.

Aurora KENOSHA
CHARGE
10006884
KARIUS TEST NGS
Rev 310
CPT 0152U
NDC NA

Fee $4,350.00

Self-Pay $2,396.62

Insurance

Minimum $2,175.00
Maximum $3,697.50
Aetna W $1,850.74
Aetna PPO $3,598.92
Anthem Blue Priority $1,993.59
Anthem Blue Preferred $1,993.59
Anthem PPO $3,697.50
Aurora Caregiver $2,081.87
Centivo $2,202.00
Cigna GPPO $2,566.13
Cigna PPO $3,679.75
Common Ground ETF Network $2,188.06
Common Ground Exchange Envision $2,188.06
Common Ground Group Envision $2,188.06
Everpointe Elite $2,017.41
Health EOS Plus $2,653.50
Health EOS PPO $3,480.00
HealthPartners ETF $1,951.29
HealthPartners Robin Focused $2,364.10
HealthPartners Broad $3,262.52
HPS $2,453.26
HST $2,397.78
Humana HPN $2,390.64
Humana HMO $2,390.64
Humana PPO $3,651.36
Molina Exchange $2,169.38
Quartz One $1,942.25
Quartz Group $2,137.62
Trilogy $2,619.61
UHC Individual Exchange $2,083.25
UHC Charter $2,083.25
UHC Nexus $2,083.25
UHC HMO $2,250.56
UHC PPO $3,680.12
WPS Aurora Featured Network $2,276.79
WPS Arise $2,396.62
WPS Statewide $2,396.62