GeneSight test cost in 2026: what Medicare pays, what you may owe, and what to ask before testing

The public numbers

Six figures that explain the GeneSight price

One number is what Medicare pays the laboratory. The rest are what the laboratory says patients pay. Mixing them up is why cost answers online seem to contradict each other.

The CMS lab fee schedule lists 0345U as a psychiatry genomic analysis panel: variant analysis of 15 genes, including deletion/duplication analysis of CYP2D6. It is a proprietary laboratory analyses code, which means it applies to one laboratory's test, the GeneSight Psychotropic panel. Other pharmacogenomic panels bill under different codes and rates, so a price for one test does not carry over to another.

With Medicare

Covered usually means $0. Not covered means a waiver you sign.

Medicare.gov says you usually pay nothing for Medicare-covered diagnostic laboratory tests. The question to settle before the swab is whether Medicare will cover this test for you.

MedPAC, the congressional advisory commission on Medicare payment, notes that services paid under the lab fee schedule carry no beneficiary cost sharing and that the rates do not vary by geography. Coverage is a separate question, and it is decided by the Medicare contractor for the laboratory, not the one for your state. The GeneSight laboratory is in Mason, Ohio, where the contractor is CGS. CGS's billing article for its pharmacogenomics policy lists GeneSight among the covered multigene panels, with an intended use of major depressive disorder or neuropsychiatric conditions.

Coverage has conditions. CGS's policy covers pharmacogenomic testing once the treating clinician has narrowed the choice to specific medications, or is already using one, that have a gene-drug interaction recognized in FDA drug labeling or in CPIC guidelines (levels A and B). The clinician who orders it must be able to both diagnose the condition and prescribe for it, and the claim must name the drug or drugs being considered. The same policy says the evidence does not support coverage for the proprietary “combinatorial” scoring itself, only for the gene results within a panel that meet those conditions. Horizon Blue Cross Blue Shield of New Jersey's policy, citing Medicare's managed care manual, says its Medicare Advantage plans follow the contractor policy for GeneSight because only one laboratory performs it, and asks for a record that at least one neuropsychiatric medication has failed or is failing.

The laboratory's cost page states: “For Medicare, if the test is considered non-covered, your clinician will need to submit an Advanced Beneficiary Notice signed by you before we can deliver the GeneSight test. By signing the ABN, you agree to pay the full cost of the test and will be billed accordingly.” The same page says all patients are eligible for the $330 self-pay option. Before signing, ask the laboratory which amount you would owe in dollars. The laboratory also says people with federally funded coverage, including Medicare, Medicaid, TRICARE, and Medicare Advantage, are not eligible for its financial assistance program.

With commercial insurance

Many plans call the test investigational. The $330 terms still apply.

Three large insurers with New Jersey members publish policies that do not pay for GeneSight-type panels. That is why the lab's self-pay price matters more than the billed charge for most commercially insured patients.

Your plan's contract can differ from its posted policy, and Horizon says many of its plans send molecular and genetic test reviews to eviCore healthcare instead, so ask the plan directly about code 0345U and whether prior authorization is required. The laboratory says it reviews your benefits when your sample arrives and contacts you before processing if your cost could be more than $330, including the option to cancel at no cost. It bills the plan after processing; the plan's Explanation of Benefits arrives in 30 to 45 days, and the laboratory's own statement can take several months.

The $5,500 question

Why an Explanation of Benefits can show thousands of dollars

An EOB shows the laboratory's billed charge and what your plan did with it. The laboratory says the EOB is not a bill. Your bill is the statement Myriad Genetics mails after the claim is complete.

Patient forums describe EOBs listing a charge of about $5,500 for GeneSight with nothing covered. That is the amount billed to the plan, not the published patient price. The laboratory's published terms are the $330 self-pay option for every patient and a call before processing if your cost could be higher than $330. If the statement you receive is higher than what you were told, call the laboratory's billing team at 888-496-2391, ask how the $330 terms were applied, and ask about the interest-free payment plan (for $100 or more) and financial assistance (for people without federally funded coverage, based on federal poverty guidelines).

Costs outside the lab price

The visit and the swab can cost extra.

The lab's prices cover the laboratory test. The clinician visits around it are billed separately.

A registered clinician has to order the test: the laboratory says this can be a primary care physician, nurse practitioner, physician assistant, or psychiatrist. The clinician collects a cheek swab in the office, or the laboratory mails a GeneSight at Home kit after the clinician orders it. The laboratory says results typically reach the clinician about three days after it receives the sample, and that samples are destroyed within 60 days. The ordering visit and the results visit are billed under your plan's office-visit rules, and some clinics add a collection charge; one psychiatry practice, for example, publishes a $275 fee for collecting the GeneSight sample. Ask the office for both amounts before the swab.

What the test shows

What a GeneSight report can and cannot tell you

The report describes how your genes may affect how you process or respond to certain psychiatric medications. It does not diagnose depression, and it does not say which medication will work.

The FDA keeps a public table of gene-drug associations it considers supported by evidence, and says inclusion in that table does not mean it advocates testing before prescribing. In a 2018 safety communication, updated in 2019, the FDA said the relationship between DNA variations and how well an antidepressant works has never been established, and told patients not to change or stop a medicine based on genetic test claims that are not supported by evidence. Medicare's CGS policy reflects the same line: it covers gene results tied to an FDA label or CPIC guidance, not the proprietary scoring on top.

The trials point the same way. In the GUIDED trial (Journal of Psychiatric Research, 2019), whose authors included employees of the test's maker, 1,167 outpatients whose depression had not responded to at least one antidepressant were assigned to GeneSight-guided care or usual care. At week 8 the primary measure, symptom improvement, was not significantly different (27.2% versus 24.4%), while response (26.0% versus 19.9%) and remission (15.3% versus 10.1%) were higher with the report.

Is it worth the cost?

Ask what the result would change before paying for it.

The evidence supports using a pharmacogenomic result as one input for selected patients, not as a routine test or a promise of response.

American Family Physician's 2021 review says the GeneSight test may assist drug selection and dosing for people having difficulty finding an effective option or who have had intolerable adverse effects after trials of several drugs, and states that routine genetic testing is not recommended. In the PRIME Care randomized trial (JAMA, 2022), 1,944 patients with major depressive disorder at 22 VA medical centers were assigned to care guided by a commercial pharmacogenomic test or to usual care. Test-guided care led to more prescriptions with no predicted drug-gene interaction. Remission over 24 weeks was slightly higher (a 2.8 percentage-point risk difference), but the difference was not significant at week 24.

Do not stop, skip, switch, or change the dose of a medication because of a report category. Review the full report with the prescriber responsible for the plan. Our antidepressant genetic testing guide explains how to read report categories and the evidence behind them. If several medications have already failed, our guide to treatment-resistant depression covers the options beyond another medication trial.