Coding & Reimbursement

  •  - In 2018, the FDA granted breakthrough designation to the MI assay in DISCERN™ and FDA review is pending.
  •  - PLA codes for DISCERN™ test have been paid for by Medicare. 
  •  - DISCERN™ test has been awarded two unique CPT (PLA) codes 206U (MI & PKC) diagnostic tests and 207U (AD index) confirmatory test.

Is the test reimbursed?

The DISCERN™ test has received reimbursement codes, payment rates and is paid for by Medicare Fee for Service and some commercial plans. When ordering the test, you will be asked to provide the patient’s insurance information. This information will be used to identify coverage for the patient and estimate out-of-pocket costs, if any.

What is needed to confirm reimbursement for the test?

As part of our service, Synaps Dx will obtain reimbursement directly from the payers, reducing the burden on your practice and on your patients. When the practice enters the patient information into the portal, Synaps Dx will assess insurance coverage and eligibility with the information provided. When completing the test request in the portal, it is important to be as complete as possible with the patient information. This will improve the accuracy of the insurance assessment. The patient insurance coverage assessment will be provided to the practice to discuss with the patient and confirm patient agreement to conduct the test and accept the identified out-of-pocket costs.

Included in the DISCERN™ kit provided by Synaps Dx is an authorization form. This form must be signed by you and the patient. Your signature authorizes the procedure, and the patient signature assigns their insurance benefit for the test to Synaps Dx for collection and has the option to opt out of SynapsDx retaining their sample for future Alzheimer’s Disease research. If this form is not completed, the test could be delayed.

What are the coverage codes for DISCERN™?

DISCERN™ has two PLA Codes assigned:

•         206U has been assigned for cell culturing and performing the Morphometric Imaging (MI) and PKCƐ assays.

•         Code 207U for the AD Index

Synaps Dx will always perform the MI and PKCƐ assays to inform a diagnosis of AD. If the results from these two assays are inconclusive, the AD-Index will be performed as a “tie-breaker.”

Will my patients have any out-of-pocket costs for the test?

The test has been reimbursed by Medicare for Fee for Service and Synaps Dx is working with other payers to ensure reimbursement.  If paid for by Medicare, your patient will bear no costs, other than those required to cover any co-pays or co-insurance requirements as determined by their insurance. If their insurance does not cover the test, you will be notified. If your patient wants to proceed, we have cash pay options available. To learn more about cash pay options, contact us at or speak to your DISCERN Diagnostic Specialist.

Will my practice incur any out-of-pocket costs to order or perform the test?

The DISCERN™ Test was designed to reduce the burden on your practice. Synaps Dx will perform the insurance discovery and seek reimbursement, provide the tools, transport containers and pre-paid shipping labels to perform the biopsy and return the sample to our lab. Synaps Dx does not provide the local anesthetic (lidocaine), syringe, or any skin adhesives that may be necessary to perform the biopsy. Synaps Dx may be able to reimburse your practice for the costs of these items for performing the DISCERN™ test. To learn more, contact us Reimbursement for performing the skin punch biopsy may be available. To find out more, please consult your billing department for proper coding and documentation requirements.

Is the biopsy procedure reimbursed?

The skin punch biopsy procedure is performed under CPT code 11104 and is associated with .83 RVU. Coverage and payment for the skin punch biopsy may vary by payer. Synaps Dx does not make any representation for coverage or payment for the skin punch biopsy procedure. Please consult your billing department to confirm appropriate coding and documentation.