Next-Generation Sequencing (NGS) & Genomics Billing Software
Protect $1,500+ allowed reimbursement rates on multi-gene sequencing panels (CPT 81432-81455), navigate commercial step therapy, and automate somatic vs germline billing crosswalks.
Next-Generation Sequencing (NGS) and genomic panel laboratories operate with extreme reagent costs ($400 to $1,200 per sequencing run). When commercial payers or Medicare MACs deny high-dollar CPT codes (e.g. CPT 81432 for hereditary breast cancer panels or 81445 for targeted somatic oncology), the laboratory incurs massive financial deficits. Payers aggressively dispute medical necessity, claim panels contain unproven genes, or demand prior authorization records that were never obtained. TravaLabs deploys an autonomous genomics billing architecture that maps gene lists directly to approved CPT codes, generates clinical necessity dossiers, and automates ERISA appeals.
Key results
- $1,850 — Average Allowed Realization per Multi-Gene Panel
- Zero-Touch — Gene-List-to-CPT Panel Code Crosswalk
- 88.4% — First-Pass Adjudication on Complex Genomic Claims
- NCCN Guidelines — Automated National Oncology Policy Cross-Referencing
Core capabilities
- Gene List to CPT Code Matrix Mapping — Instantly identifies the most specific and compliant CPT panel code (e.g. 81432 vs 81479 unlisted) based on the exact gene list sequenced in the assay.
- NCCN & ACMG Clinical Utility Evidence Compiler — Automatically pairs claims with published National Comprehensive Cancer Network (NCCN) category 1/2A guidelines to dismantle medical necessity objections.
- Germline vs Somatic Split Billing Automation — Ensures correct place of service, ICD-10 staging, and MolDX modifiers are applied based on whether testing evaluates inherited risk or tumor biology.
- Genomic Prior Authorization Rapid Escalation — Pre-screens orders against payer genetic testing medical policies (e.g. UnitedHealthcare genetic testing policy criteria) before sequencer loading.
Frequently asked questions
How does TravaLabs handle commercial denials claiming a gene panel is investigational?
Our appeal engine automatically attaches FDA approval documentation, NCCN clinical practice guidelines, and peer-reviewed utility studies demonstrating the panel improves clinical outcomes, overturning investigational denials under ERISA.
Can the software distinguish between whole exome sequencing (WES) and targeted gene panels?
Yes. TravaLabs applies exact coding logic for WES (CPT 81415), whole genome sequencing (81425), and targeted panel codes (81432-81455), ensuring appropriate modifier usage and avoiding unbundling penalties.