Does Medicare Cover the Vectra DA Test?

The Vectra DA test is a blood test used to measure disease activity in people who are diagnosed with rheumatoid arthritis. It is important to know that this test is not used to diagnose rheumatoid arthritis. Instead, it monitors disease activity for those who already have rheumatoid arthritis.

For those who need this test, a common question for many is “does Medicare cover the Vectra DA test?” In this article, we answer that question in clear, plain English. You will also find the average costs of the Vectra DA test if you have to pay for it out of pocket.

Does Medicare Cover the Vectra DA test?

The short answer is yes; Medicare will cover the cost of the Vectra DA test. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your Vectra DA test. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for the Vectra DA test. Parts A and/or B provide coverage for your Vectra DA test if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

As of now, there is not yet a national coverage policy for Vectra DA tests, according to the Centers for Medicare and Medicaid Services, or CMS. However, to report a Vectra DA service, the following claims must be submitted according to the CMS website:

1 unit of service or UOS
The appropriate DEX Z-Code™ identifier adjacent to the CPT® code in the comment/narrative field for the following Part B claim field/types:
- Loop 2400 or SV101-7 for the 5010A1 837P
- Item 19 for paper claim.
The appropriate DEX Z-Code™ identifier adjacent to the CPT® code in the comment/narrative field for the following Part A claim field/types:
- Line SV202-7 for the 837I electronic claim
- Block 80 for the UB04 claim form
The appropriate ICD-10-CM code

Once approved, Original Medicare provides coverage for two Vectra DA tests every year. Most of the time, Original Medicare covers 100 percent of the costs of medically necessary laboratory tests, including hepatitis C screenings.

Part C Coverage for the Vectra DA Test

Medicare Advantage plans (Medicare Part C) also provide coverage for Vectra DA tests. They have to. Part C plans much cover all the same tests, services and treatments that Original Medicare covers. These plans will also cover some additional benefits as well. The additional benefits they will cover, and how much the plans cost, will vary from plan to plan.

How Much Does the Vectra DA Test Cost?

The average cost of a Vectra DA test is around $1,000 for those who have to pay for it out of pocket. Financial assistance may be available for those who don’t have insurance coverage to cover the costs of this test.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.