Athena Diagnostics offers several ordering and billing options to meet the specific needs of each medical practice. The following information can be used to determine the best option for you and your patients.
For more information, contact an Athena Billing Specialist at (800) 394-4493, extension 4 from 8:00 AM to 8:00 PM eastern time.
Direct Institutional BillingAthena Diagnostics, where permissible, will bill a Hospital, Reference Laboratory, and/or a Clinic directly for all services performed for a patient.
CPT Code ListingThe CPT codes provided by Athena Diagnostics are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
Terms and Conditions
Athena Diagnostics sends invoices every 30 days for testing that has resulted during the previous 30 days. Payment is due upon receipt. Customers who have signed agreements with Athena Diagnostics should follow the terms and conditions outlined in the agreement.
Athena Alliance Program
Effective September 1, 2014, Athena Diagnostics will provide greater personalized service to physicians and patients via the Athena Alliance Program.
Customer and Patient Support
Our Billing Services Department will provide personalized patient services from start to finish.
- Personal Service - Each patient will have an assigned specialist and team of dedicated personnel to support them from the time a test is ordered through the entire billing cycle.
- Letters of Medical Necessity - We will work with physician practices to submit letters of medical necessity to the patient’s insurance company and to obtain determination of patient financial responsibility if available.
- Billing Support - We will bill a patient’s insurance and file appeals as appropriate.
Athena Diagnostics offers financial assistance to patients in all 50 U.S. states, regardless of insurer, based on current published Federal Household Income guidelines
In-Network Commercial Insurance
Patients with a commercial insurance plan for which Athena Diagnostics is a contracted provider are subject to the deductible, co-insurance or co-pay obligations of their plan. We will bill insurance directly for all of our services with no up-front charges paid to Athena Diagnostics by the patient unless testing is not covered by the contracted payer. We will forward the appropriate notification of obligation to the patient as specified by the Explanation of Benefits (EOB). In all instances, Athena Diagnostics will adhere to the terms of the patient’s individual policy insofar as payments for services are concerned. Patients should check with their local provider for pre-authorization and coverage questions related to our services. When possible, Athena Diagnostics will provide pre-authorization concierge support for the clinician and patient before the sample is drawn.
The following insurance plans are in-network:
- Blue Cross Blue Shield of MA
- Blue Cross Blue Shield of NM
- Federal Blue Cross Blue Shield
- Fallon Community Health Plan
- Harvard Pilgrim Health Care
Out-of-Network Commercial Insurance
Athena Diagnostics accepts all commercial insurance plans, however, we do not have contracts with all commercial insurance plans. We will file claims and appeals with a patient's insurance plan. Athena Diagnostics will bill the patient for any charges not paid by the insurance.
For plans that send payment directly to their members (including many BCBS plans), Athena Diagnostics also requires a deposit of $100 from the patient in order to proceed with testing. The patient must also agree, that if they receive payment from their insurance carrier for Athena services, they will endorse the check and send it to:
P.O. Box 638396
Cincinnati, OH 45263-8396
Government Health Plans
For registered hospital inpatients and/or outpatients that have Medicare coverage, Athena will bill the hospital directly. For all other Medicare patients, Athena Diagnostics will submit claims to Medicare Part B (in Massachusetts) for all of our non-molecular tests. Patients with Medicare Part B are not responsible for any payment for non-molecular tests. A signed and completed Advance Beneficiary Notice (ABN) is required for molecular tests, as Medicare may not cover molecular testing.
Athena will file claims with the patient’s health plan. The patient will be held liable for any balance due as indicated on the Explanation of Benefits (EOB). If the patient responsibility is more than $250.00 the patient may qualify for financial assistance.
Athena Diagnostics is not a participating provider in any Medicaid program. Medicaid patients may qualify for financial assistance.
Uninsured or Self-Pay Patients
Athena Diagnostics offers a discount to patients who are uninsured or who wish to pay out-of-pocket. For specific details, please see the Athena Alliance Program above.