Company: BLLN
Filing Date: 2025-08-11
Form Type: DRS/A
Source: 0000950123-25-007483
Chunk: 222

Company: BillionToOne, Inc.
Filing Date: 2025-08-11
Form: DRS/A
Chunk 222
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. We plan to expand our Medicaid participation as our geographical footprint continues to grow, ensuring access to our tests for underserved populations. While Medicaid broadly covers carrier and aneuploidy tests, reimbursement rates vary significantly across state Medicaid programs. Moreover, various managed Medicaid payors may not have any out-of-networkbenefits, resulting in non-paymentsuntil they agree to contract with our laboratory, creating variability in our reimbursement from this payor segment. 62 Billing and claims processing Laboratory tests are classified for reimbursement purposes under a coding system known as Current Procedure Terminology (CPT), which we and our customers must use to bill and receive reimbursement for our diagnostic tests. Once the American Medical Association (AMA) establishes a CPT code, the Centers for Medicare & Medicaid Services (CMS) establishes payment levels and coverage rules under Medicare, while state Medicaid programs and commercial health plans establish rates and coverage rules independently in accordance with applicable rules. A Proprietary Laboratory Analyses (PLA) code is part of the CPT code set and may be assigned to tests that are not covered by standard CPT codes. We utilize a combination of established CPT codes and recently obtained PLA codes for billing and reimbursement of our tests. We use established CPT codes for certain tests, including our aneuploidy NIPT which CMS has a pricing rate of $759 per test. For other proprietary tests, we use PLA codes, including our carrier panel which CMS has a pricing rate of approximately $1,825 per test. We have also obtained PLA codes for our Northstar Select and Northstar Response tests, which CMS has pricing rates of approximately $2,920 per test and $1,644 per test, respectively. The transition from miscellaneous codes to specific PLA codes has enhanced our reimbursement clarity and is expected to continue to improve our ASPs as these codes are increasingly recognized by commercial third-party payors. Despite favorable coding and high coverage rates for many of our tests, we face reimbursement challenges in certain scenarios. For example, for out-of-networkclaims with Managed Medicaid plans, we may receive no reimbursement. Even for commercial insurances with out-of-networkbenefits, the percentage of allowed

| 62 |     | In addition, our carrier screen test is not covered by Alabama, Michigan, or Nevada, and our aneuploidy test is not covered by Nebraska, Nevada or Utah. State Medicaid coverage is currently rare for our RhD and fetal 
 antigen tests, and is limited for our oncology tests, as the latter is covered at