Welcome

Internal Resources for VUMC Providers & Staff

What is the PREDICT (PDX) test?

The PREDICT (PDX) test, also known as “Pharmacogenomics Panel”, is a one-time, panel-based laboratory test performed in the molecular diagnostics lab. This test empowers patients and doctors with important pharmacogenomic (PGx) information needed to predict and help prevent expensive adverse drug events.

Why would a doctor order the PREDICT test?

Each person responds differently to medicines. Genes play a role in how patients will respond to medicines. Based on the patient’s history, a provider may order a test to learn more about which drugs are right for the patient. Having this information may help predict and prevent bad drug side effects.

What does the test include?

CPT

CDM

Gene

Description

81225

76008002

CYP2C19

Antiplatelet (e.g., clopidogrel); antidepressant; antiepileptic; proton pump inhibitors; anti-pain (analgesic)

81226

66000878

CYP2D6

Antidepressant; beta blockers, antiarrhythmic; antihistamine, anti-pain, opioids, antipsychotic

81328

76008028

SLC01B1

Statins

81231

66000829

CYP3A5

Immunosuppressant (e.g., tacrolimus)

81335

66000829

TPMT

Thiopurines (purine antimetabolites widely used in the treatment of acute lymphoblastic leukemia, autoimmune disorders (e.g., Crohn's disease, rheumatoid arthritis), and organ transplant recipients)

81227

66000845

CYP2C9

Anticoagulant (e.g. warfarin)

81355

66000852

CYP2C9/VKORC1

Anticoagulant (e.g. warfarin)

81479

66000894

CYP4F2

Anticoagulant (e.g. warfarin)

Will insurance pay for it?

Insurance companies may have a contract with Vanderbilt to discount the charge. Therefore, patients’ out-of-pocket expense will vary based on that contract, their deductible, etc. In some cases, the payer may consider the laboratory test to be a non-covered service. Once the patient receives the PREDICT test, a claim is submitted to the patient’s insurance company, and the insurance company pays the contracted price. If the claim is denied, the patient is fully responsible for the payment.

Who is responsible for any unpaid portion after insurance?

If the payer denies payment, the patient is personally and fully responsible for payment. That is, the patient will pay personally, either out-of-pocket or through any other insurance that the patient may have.

Is a waiver or Advance Beneficiary Notice (ABN) required for the PREDICT test?

Yes. Please follow your clinic’s existing process for obtaining all waivers for potentially non-covered services.

Patients with private insurance should sign a waiver of non-covered services, which acknowledges that the patient is aware that the patient will be financially responsible in the event that the test is not covered by the insurance.

Patients with Medicare will need to sign an ABN prior to testing indicating that the patient is aware that he or she will be financially responsible in the event that the test is not covered by Medicare.

Advance Beneficiary Notice of NonCoverage (ABN)

Advance Notice of Financial Responsibility (for non-covered items or services for non-government payors)

Who will the bill be from?

Patients may receive a bill from Vanderbilt University Medical Center (VUMC) for fees including the PREDICT laboratory test. Depending on the care provided, patients may receive other bills associated with his or her appointment.

What diagnosis (ICD-10) codes are commonly associated with this test?

Providers should select an appropriate diagnosis code to reflect the screening nature of the lab service provided.

Where can patients find the test results and other information about the PREDICT test?

Patients may view their PREDICT test results in “My Health at Vanderbilt” under the “Genes Affecting my Medicines” section of “My Results”. Additionally, patients may contact their doctor for test results or additional information. Doctors and other members of the patient’s care team may view their results in the Electronic Health Record.

If you have questions about the PREDICT program, please email predict@vanderbilt.edu, or for general information about PREDICT visit www.mydruggenome.org.

Patients with billing related questions should contact the Vanderbilt University Medical Center Patient Billing office at 615-936-6523 or toll free at 877-503-6890.