FSHD1 and FSHD2
Thank you for choosing the University of Iowa Diagnostic Lab for your FSHD1 and FSHD2 testing needs!
Please review the information below before submitting a specimen to UIDL for testing. Ready to send a sample?
Frequently asked questions
Where can I find pricing information and CPT codes for FSHD testing?
Select from the billing directives below to confirm pricing and the appropriate CPT codes relevant to your billing selection:
Can I send a sample before vetting insurance?
We realize it’s not always feasible to fully vet insurance before collecting a sample, so you can direct the UIDL to process and hold the specimen until your institution completes this process:
- Upon specimen receipt, UIDL will process and hold the specimen to allow the Referring Institution time to vet insurance.
- Testing will not begin, and the sample will remain on a billing hold until the Referring Institution contacts the UIDL Reference Billing team via email (UIDL-Billing@uiowa.edu) or phone (866-844-2522) to confirm the billing directive and initiate testing.
Test orders will be cancelled after 6 months if the referring institution does not contact UIDL to initiate testing and confirm the billing directive.
What if my referring institution is located outside the U.S.?
- Prepayment is required before the UIDL will perform testing unless the UIDL has previously approved client invoicing.
- The FSHD1 & FSHD2 International Requisition will need to be completed and sent with the specimen.
Where can I find test criteria and sample collection details?
- The Test Directory provides basic test and sample handling information.
- The FSHD Diagnostic Workflow provides additional test details.
How do I request a sample collection kit?
Once insurance and billing directives are in place, please use the supply order request form.
Where can I find an ABN for FSHD lab testing?
The ABN for FSHD lab testing can be downloaded here. Please see Medicare Resources for additional ABN and Medicare billing details.
Where can I learn about prenatal FSHD testing?
Please visit our prenatal FSHD testing FAQ. The prenatal FSHD testing requisition will need to be completed and sent with the specimen.
FSHD1 and FSHD2 process steps: quick reference
- Referring Institution confirms billing directives.
- If prepayment is necessary, designated payer and UIDL Billing will arrange payment.
Once prepayment is received or confirmed unnecessary, the referring institution can request an FSHD sample collection kit by filling out the form below:
- Patient and provider coordinate sample collection, and return the sample with a fully executed requisition, any applicable insurance information, and pertinent clinical history.
- Once any pre-authorizations, billing holds, or insurance discrepancies are resolved, UIDL performs testing and reports results.
Where to begin
To avoid testing delays, a billing directive should be established before a sample collection kit is requested.
In some cases, prepayment may be required, or commercial insurance may require prior authorization. Patients and/or referring physicians are responsible for vetting third-party payer coverage. This includes determining whether prior authorization is needed and if the patient has out-of-network laboratory benefits which will allow payment to the UIDL.
The UIDL FSHD1 and FSHD2 test requisition (previewed above) allows you to select from one of three billing directives.
Billing directives
Expand the options below to review CPT codes, prepayment criteria, and details relevant to each option:
Referring institution (client)
This will direct UIDL to bill the referring institution directly for services upon test completion. Upon specimen receipt, UIDL will address any sample or requisition discrepancies and process the sample for testing.
If the referring institution is not located within the United States, prepayment is required unless previously approved by UIDL. Please contact UIDL-Billing@uiowa.edu to initiate approval.
Applicable CPT codes and client rates for the FSHD panel and individual panel components:
| Test Order | CPT | Maximum Charge |
| FSHD1 and FSHD2 Panel | Technical: 81404 (x1), 81479 (x2) Professional: G0452 (x1) | $2,600.00 |
| Component | CPT | Total Charges |
| Optical Mapping - Determine allele size and haplotyping | Technical: 81404 (x1) Professional: G0452 (x1) | $1,300.00 |
| Methylation | Technical:81479 (x1) Professional: G0452 (x1) | $714.00 |
| NGS (SMCHD1, LRIF1, DNMT3B) | Technical: 81479 (x1) Professional: G0452 (x1) | $714.00 |
Pricing is subject to change. | ||
Patient insurance
Patients and/or referring physicians are responsible for vetting third-party payer coverage. This includes determining whether prior authorization is needed and if the patient has out-of-network laboratory benefits that will allow payment to UIDL.
Important: Prepayment is required for non-Iowa residents with non-Iowa Medicaid or no insurance coverage. Please visit our prepayment webpage to learn more about this process.
UIDL TIN: 42-6004813
UIDL NPIs:
- Technical: 1811984636
- Professional: 1265433676
Applicable CPT codes and insurance rates for each FSHD panel component:
| Component | CPT | Insurance Rate |
| Optical Mapping - Determine allele size and haplotyping | Technical: 81404 (x1) | $1,626.00 |
| Methylation | Technical: 81479 (x1) | $932.00 |
| NGS (SMCHD1, LRIF1, DNMT3B) | Technical: 81479 (x1) | $1,672.00 |
| Professional Interpretation | Professional: G0452 (x1) | $145.00 |
Pricing is subject to change. | ||
Medicare details:
All Medicare cases must be accompanied by a fully executed Advanced Beneficiary Notice (ABN). This entails:
- Completion of sections D, E, and F. A template ABN containing this information is available for use.
- Selection of one option in Section G.
- Option 1: The UIDL will file a claim on the patient’s behalf and issue a statement of charges reflecting any residual patient/guarantor responsibility after the claim is fully adjudicated.
- Option 2: Prepayment is required for non-Iowa patients.
- Exception: for Iowa patients, the UIDL will issue a statement of charges to the guarantor upon completion of testing.
- Patient signature and date in Sections I and J, respectively.
If a fully executed ABN cannot be obtained, the patient selects Option 2 from Section G, or the referring institution declines financial responsibility for the charges, testing will require prepayment.
Important: Medicare will only pay for the services that it determines to be “reasonable and necessary” under section 1862(a)(1) of the Medicare Law. If Medicare determines that a particular service, although it would otherwise be covered, is not “reasonable and necessary” under the Medicare standards, Medicare will deny payment for that service or test.
Prior authorization details:
When ordering individual panel components, especially optical mapping, UIDL recommends securing prior authorization that includes all aspects of testing. If additional testing is required, having prior authorization on file that includes all components will expedite result reporting and patient care.
If prior authorization is required, the prior authorization number will need to be included on the requisition with the specimen. UIDL will review the prior authorization and reach out to the billing contact to resolve any discrepancies before testing begins.
If prior authorization cannot be obtained and the referring institution declines financial responsibility for the charges:
- Non-Iowa residents will be required to submit prepayment.
- Iowa residents will receive a statement of charges from UIDL to the guarantor upon completion of testing.
United Healthcare Prior Authorization (PA): Three separate PAs are required to vet coverage.
| PA #1 | Detection of Abnormal Alleles (Optical Mapping) | CPT 81404 |
| PA #2 | Methylation Status | CPT 81479 |
| PA #3 | NGS (SMCHD1, LRIF1, and DMNT3B) | CPT 81479 |
Patient (self-pay)
Iowa residents will receive a statement of charges from the UIDL to the guarantor upon completion of testing.
Prepayment is required for non-Iowa residents with non-Iowa Medicaid or no insurance coverage.
Applicable CPT codes and self-pay rates for the FSHD panel and individual panel components:
| Test Order | CPT | Maximum Charge |
| FSHD1 and FSHD2 Panel | Technical: 81404 (x1), 81479 (x2) Professional: G0452 (x1) | $2,600.00 |
| Component | CPT | Total Charges |
| Optical Mapping - Determine allele size and haplotyping | Technical: 81404 (x1) Professional: G0452 (x1) | $1,300.00 |
| Methylation | Technical:81479 (x1) Professional: G0452 (x1) | $714.00 |
| NGS (SMCHD1, LRIF1, DNMT3B) | Technical: 81479 (x1) Professional: G0452 (x1) | $714.00 |
Pricing is subject to change. | ||
Additional helpful tips:
- An order for the full FSHD1 and FSHD2 panel is not required; providers must be specific on the UIDL FSHD test requisition whether the full panel or individual components are requested.
- Note, there will always be one professional charge irrespective of what test is ordered.
- An order for a full panel may not require performance of all the components, and UIDL will only bill for the work performed.
- Please know that the amount of testing that will ultimately be performed on a specimen when an order for the full panel is requested cannot be determined prior to the start of the testing.
- In general, the minimum amount of testing performed is optical mapping to determine allele sizes and haplotyping.
Please refer to FSHD diagnostic workflow for more detail.
Still have questions?
For billing and insurance related questions contact the UIDL Reference Billing team: