Oncotype DX Breast Recurrence Score Test Providers Coverage

Coverage

We’re committed to helping your patients make confident, informed treatment decisions. That’s why we’re here to help them understand the cost and coverage of our tests.

A nurse looking at a tablet with an elderly couple.

The Oncotype DX Breast Recurrence Score^® test is widely covered for patients with early-stage HR+, HER2- breast cancer.†

Financial assistance calculator

*This calculation includes patients with Medicare, Medicare Advantage, Medicaid, Managed Medicaid, and commercial insurance. Patient cost-sharing amounts, including deductibles and copays, will vary by plan and coverage type. Only your insurer can confirm if and how the Oncotype DX Breast Recurrence Score test will be covered. Patients with high-deductible plans may receive a bill for most or all of the Oncotype DX Breast Recurrence Score test if they have not satisfied their deductible. The numbers cited are based on historical patient billing data from 01/02/2025-12/31/2025. Rates of coverage vary by state and region. Exceptions for coverage may apply. Exact Sciences strongly encourages you to contact your insurer with questions about Oncotype DX Breast Recurrence Score test coverage.

We work with insurance companies to help get coverage for the Oncotype DX Breast Recurrence Score test.*

While most commercial carriers cover the Oncotype DX Breast Recurrence Score test for eligible patients, coverage varies by product and plan. We recommend your patients contact their insurer to understand their specific benefits.
Exact Sciences‡ is an in-network provider with many health plans, including Aetna, Anthem, Cigna, Humana, and UnitedHealthcare.

$0 financial responsibility for Medicare Part-B when coverage criteria are met*

Medicare Part-B and Medicare Advantage plans cover the Oncotype DX Breast Recurrence Score test for eligible patients.
Medicare Advantage, which is provided by commercial insurance companies, may have different out-of-pocket costs compared to Medicare Part-B.

The 14-Day Rule

Medicare Part-B has specific guidelines for reporting certain lab tests and pathology services for Medicare patients. These are commonly known as the ‘14-Day Rule'. Download our Provider 14-day Rule Guide

We believe that everyone should have the opportunity to be as healthy as possible, no matter who they are, where they live, or how much money they make.

We’ll work with your patients to help them understand their coverage and payment options. Our estimator tool can also help determine whether they qualify for financial assistance.§

A doctor looking at the patient assistance calculator on a laptop.

Billing and coverage process

Because insurance coverage can vary by plan and location, it can be difficult to understand the cost of testing. That's why we offer support throughout the billing and coverage process.

Step 1

Order the test

We check your patient’s coverage and will work with your office and their insurance provider to submit prior authorization when needed.

Step 2

Once results are ready, we’ll submit the insurance claim

Patients will receive an Explanation of Benefits (EOB) from their insurance provider explaining whether they owe any out-of-pocket costs.

Step 3

We'll help your patients with appealsa

If your patient’s insurance denies payment, Exact Sciences can submit an appeal for your patient.

Download our Prior Authorization Tip Sheet (PDF)

Step 4

We’ll let your patient know if they owe anything

After we finish working with the patient’s insurance, they’ll receive a bill from Exact Sciences if they have a remaining balance.

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References

Exact Sciences performs the services ordered and deemed medically necessary, regardless of network provider status.
The Oncotype DX^® Breast Recurrence Score test is widely covered for patients that have recently been diagnosed with node-negative or node-positive HR+ and HER2- invasive breast cancer that are medically eligible for chemotherapy.
Genomic Health, Inc., an Exact Sciences company, is the billing entity for the Oncotype DX^® test.
Exact Sciences may change or update its program criteria at anytime, without notice. Eligibility is not guaranteed. Exact Sciences may require that a patient provide proof of financial need if their information is not already available to Exact Sciences.

a　If your patients claim is denied, Exact Sciences can help appeal the decision on their behalf. We will contact them directly. It's important that they sign and return the consent forms as soon as possible to avoid delays.

The Oncotype DX Breast Recurrence Score test was developed, and the performance characteristics validated by Genomic Health, Inc., following College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA) regulations. The Oncotype DX Breast Recurrence Score test is performed at the Genomic Health Redwood City clinical laboratory. Abbott clinical laboratories are accredited by CAP, certified under CLIA regulations, and qualified to perform high-complexity clinical laboratory testing. This test has not been cleared or approved by the US Food and Drug Administration or other notified regulatory authority.

Helping your patients navigate coverage

84% of patients paid $0* 89% paid less than $100*

Employer-sponsored or commercial insurance

Medicare, Medicare Advantage and Medicaid

Exact Sciences Patient Assistance Program

Billing and coverage process

Step 1

Order the test

Order the test

Step 2

Once results are ready, we’ll submit the insurance claim

Once results are ready, we’ll submit the insurance claim

Step 3

We'll help your patients with appealsa

We'll help your patients with appealsa

Step 4

We’ll let your patient know if they owe anything

We’ll let your patient know if they owe anything

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References

Billing and coverage process

Step 1

Order the test

Order the test

Step 2

Once results are ready, we’ll submit the insurance claim

Once results are ready, we’ll submit the insurance claim

Step 3

We'll help your patients with appealsa

We'll help your patients with appealsa

Step 4

We’ll let your patient know if they owe anything

We’ll let your patient know if they owe anything