A Better Path to OB/GYN Profitability: Genetic Testing Revenue

Women’s health practices and health systems are constantly exploring pathways to strengthen financial performance. However, a high-impact revenue stream often remains untapped: in-house genetic testing. Genetic panels in OB/GYN practices are already being ordered in high volumes, yet most practices outsource them to reference labs without realizing there’s an opportunity to capture this high-yield revenue without a huge administrative and operational undertaking.

Whether your practice has an existing physician-owned laboratory or wants to further explore the possibility, in-house genetic testing offers a scalable, high-value service line that enhances both clinical care and financial performance for OB/GYN practices looking to optimize profitability.

Why OB/GYN Practices Are Perfectly Positioned for Genetic Testing

OB/GYN practices are perfectly positioned to benefit from genetic testing services due to the following factors:

• High-Volume Testing: ​Obstetricians and gynecologists are among the highest growing demanded specialists in the physician space. This high demand underscores the substantial patient volume that OB/GYN practices handle, suggesting that integrating genetic testing services can further capitalize on this scalability to enhance patient care and practice profitability.
• Clinical Alignment: OB/GYNs are already familiar with genetic testing in their practice, such as NIPT (non-invasive prenatal testing), Carrier Screening, and other genetic tests that are routinely ordered for patients during prenatal care visits. They order these tests as part of standard care for pregnant and pre-conception patients. Bringing the testing in-house can make a significant impact on a practice’s financial health and can be done with minimal workload and changes to staff, if it’s done with the right partner.
• Patient Demographics: OB/GYN practices see a high volume of reproductive-aged women. As genomics in the maternal medicine space become more accessible and attractive to this demographic, offering genetic tests as routine prenatal care in your practice enhance overall patient care and health plans.

However, despite the strategic alignment, many OB/GYN practices are still outsourcing these high-reimbursement tests to external labs. This means practices are not getting paid for the services they’re already providing. It’s a missed opportunity to generate significant revenue and keep the testing process within their own control.

How To (Successfully) Turn Genetic Tests Into OB/GYN Revenue

OB/GYN profitability can be maximized by taking advantage of the reimbursement potential that high-yield genetic tests offer. Carrier Screens average reimbursement to laboratories range from *$600 or more per test. NIPT tests have an even higher potential reimbursement return averaging between *$700-$800 per test. These numbers vary by payer, states, and patient health insurance plans, but the positive impact on a practice’s bottom line is virtually guaranteed if they bring this genetic testing in-house—but only if it’s successfully billed and collected.

Where Incompetent OB/GYN Medical Billing Can Leak Genetic Revenue

OB/GYN revenue cycle management for lab services, and specifically genetic testing, is far more complex than standard office visits or procedures.  Many OB/GYN medical billing companies aren’t equipped for the nuanced coding and documentation needed for genetic testing reimbursement. This is where OB/GYN practices can lose significant time, resources, and revenue by not planning for efficient laboratory billing and collecting before incorporating genetic testing in-house. Even if the test is performed correctly, the volume is high, and the proper contracts are in place, claims can be denied or underpaid if submitted without the right documentation or coding. That’s why PhytestDX is more than just a laboratory management partner—we ensure your practice has the right infrastructure and RCM strategy in place to make every genetic test financially meaningful.

Specialized OB/GYN Billing Services for Genetic Testing

At PhytestDX, we partner with our sister company, Phytest, which specializes in laboratory RCM and OB/GYN laboratory billing services. Unlike generalist medical billing companies, Phytest understands the nuances of OB/GYN laboratory billing codes, payer policies, and the ever-evolving landscape of genetic testing reimbursement. Our laboratory RCM model is tailored exclusively to laboratory services and built to maximize reimbursement for in-house genetic testing through:

• Accurate CPT coding for NIPT, carrier screening, and other OB/GYN-specific genetic panels.  These CPT codes may depend on the patient’s ethnicity and family history.
• Proper use of diagnosis codes (ICD-10) that align with payer medical necessity policies.
• Navigating payer-specific prior authorization requirements.
• Appealing denials and underpayments with payer-specific insight and documentation protocols.
• Timely filing for claim submissions by payer-specific timelines after date of service (DOS).

Starting or Expanding a Genetics Program to Enhance OB/GYN Profitability

Whether your practice already has an in-house laboratory or is considering building one, integrating genetic testing into your services can be a highly profitable venture. Here’s how both scenarios present unique opportunities to enhance revenue and OB/GYN profitability:

For Practices with an Existing Lab: Expanding into Genetics

If your practice already operates an in-house lab, expanding into genetic testing is a natural and profitable next step. Here’s how we can optimize a current laboratory:

1. Maximizing Existing Resources: By adding genetic testing to your lab’s offerings, you can leverage existing infrastructure and equipment to increase profitability. If your laboratory is currently not certified as a high-complexity laboratory that is capable to run genetic tests, our team has strategies to easily and efficiently build the bridge to get your existing space into a fully-managed genetics operation.
2. Minimal Laboratory Disruption: Our team can bring our genetic expertise into an existing in-house laboratory without disrupting the current environment. We provide support, infrastructure, and RCM for the genetics program alone, while your practice can continue existing laboratory operations and workflows as normal.
3. Completely Managed Genetics Program: PhytestDX handles every aspect of launching a practice’s in-house laboratory genetics program. From licensing to staffing, and validations to collections, practices benefit from ongoing management of their new genetics program beyond the initial launch.

For Practices Without a Lab: Building One for Long-Term, Reliable Revenue

For practices without an in-house laboratory, the thought of building one may seem like a daunting administrative undertaking. However, we present OB/GYN practices with a different, mutually invested approach. Here’s how PhytestDX can help practices generate a new revenue stream without requiring any heavy lifting:

1. A Fully Managed Turnkey Solution to Laboratory Revenue: PhytestDX helps design and build your lab, ensuring you have the right equipment and setup from the start. Once your lab is operational, we manage all aspects of day-to-day operations, licensing and credentialing, staffing, clinical quality control, and revenue cycle management. Our approach allows your practice to focus on patient care while we ensure that every test is not only clinically excellent by the highest laboratory standards but also reimbursed at the highest rates possible.
2. Internal Education and External Resources: Starting a new in-house laboratory requires the support from your practice’s providers as well as extended patient education on your new ancillary laboratory offerings. Our team distributes resources to both providers and patients that promote the laboratory and the tests that the practice can now run in-house.
3.  A Profitable, Scalable Investment: The upfront investment required to build an in-house OB/GYN laboratory can produce a faster, greater, and more reliable return leveraging our approach with a genetics program compared to traditional models. By allowing our team to completely handle buildout, operations, and revenue cycle management, we are driven to ensure your laboratory becomes a profit-center.

Ready to Unlock the Potential of In-House Genetic Testing?

If you’re ready to explore how in-house genetic testing can benefit your OB/GYN practice, we invite you to take the next step. Contact our team to start the conversation today.

Start optimizing your OB/GYN profitability and patient care with PhytestDX and Phytest today.