Company: VCYT
Filing Date: 2025-02-28
Form Type: 10-K
Source: 0001384101-25-000014
Chunk: 14

Company: VERACYTE, INC.
Filing Date: 2025-02-28
Form: 10-K
Item: Item 1
Chunk 14
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 the payers as a “contracted provider” or do not have a contract and are considered a “non-contracted provider.” Payers will often reimburse non-contracted providers, if at all, at a lower rate than contracted providers. 

When we contract to serve as a contracted provider, reimbursements are made pursuant to a negotiated fee schedule and are limited to only covered indications. Becoming a contracted provider generally results in higher reimbursement for covered 

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indications and lack of reimbursement for non-covered indications. As a result, the impact of becoming a contracted provider with a specific payer will vary.

In some cases, third party payers may request audits of the amounts paid to us. This may require us to repay certain amounts to payers as a result of such audits.

Factors that impact reimbursement include, among others:

•variability in medical policies indicating coverage for our products and services;

•network status and claims adjudication as in-network or out of network and corresponding patient co-pay/coinsurance responsibilities;

•patient financial assistance programs;

•changes to American Medical Association's CPT coding rules and edits;

•Medicare clinical laboratory and physician fee schedules;

•government sequestration;

•Medicaid fee schedules;

•contracted rates for our diagnostics;

•utilization management or prior authorization processes and steps put in place by commercial payers ensuring medical necessity of services ordered for patients;

•billing errors; and

•claims disputes.

For the years ended December 31, 2024, 2023 and 2022, respectively, revenue was represented by the indicated percent for each payer: 

Medicare accounted for 33%, 35% and 36% of our testing revenue. Medicaid accounted for 1%, 1%, and 3% of our testing revenue. Private commercial payers, including Medicare advantage, accounted for 66%, 64%, and 61% of our testing revenue.

In Vitro Diagnostic Tests 

For our IVD tests, we bill hospital and laboratory customers directly for test kits they order. Our customers subsequently bill third-party payers for reimbursement. We continue to drive Prosigna reimbursement efforts in Europe and other global markets through the development of clinical and other evidence to support the test’s inclusion in guidelines and coverage programs. The test is currently reimbursed in Germany, France, Spain, Portugal, Italy, Netherlands, Norway, Sweden, Denmark, Austria, Lithuania, Switzerland, Canada, England, Scotland, and Israel.

Competition

Our main competition are companies that use next generation sequencing technology