Aegis provides clinician-reviewed molecular test consultations to help physicians get patient treatment right the first time.
When physicians have precise, patient-specific treatment recommendations, they are enabled to prescribe the right treatments the first time. This reduces the trial-and-error cycle that drives downstream costs for your plan.
A clinical pharmacist reviews each patient’s test results against their full medical record, including active medications, diagnoses, and care history. They check for interactions and flag contraindications.
A board-certified molecular pathologist reviews and approves every report before it reaches the treating physician. No result goes back without clinical sign-off.
For your plan, that means treating physicians receive lab results with real clinical context and recommendations that account for the patient’s full situation. Healthier members cost less to treat.
When a patient gets the wrong antibiotic, the wrong dosage, or a drug that interacts negatively with something they are already taking, costs escalate through ER visits, specialist referrals, hospital readmissions, and adverse drug events. Aegis minimizes the cycle.
A 72-year-old member on multiple medications does not get prescribed an antibiotic that interacts with her statin. The right treatment gets prescribed the first time.
A member who is a poor metabolizer of a common SSRI does not spend six months on a drug that is not working. The right medication gets selected before the prescription is written.
This consultation costs significantly less than a downstream event that costs your plan 20X to 200X more.
Every Aegis consultation generates data that supports medical necessity—proving tests are clinically justified, consultations are warranted, and treatment recommendations are patient-specific. Software-only or algorithmic interpretation services do not produce documentation because they are not clinical practices.
For your claims team, audit-ready documentation is available. The ordering physician NPI, the date of service, the clinical rationale, and the full consultation report are all available for review.
Aegis Health Services provides professional, physician-led diagnostic consultations. Our services are distinct from laboratory testing, which impacts how claims should be processed.
There may be some unfamiliar codes on an Aegis claim because few pathologists specialize in molecular test interpretation, but the codes, the services, and the billing methodology are all standard. Aegis billing uses pathology consultation codes (CPT codes 80503 through 80506). These are AMA-recognized codes for pathology clinical consultation services. Aegis may also use principal care management (PCM) codes in appropriate situations.
Aegis bills your plan directly. If the member has a copay, coinsurance, or deductible, cost-share flows to the patient.
For Medicare Advantage plans or value-based care contracts, Aegis consultations contribute to the documentation and care coordination metrics that drive quality bonus payments.
Complete clinical narratives generated for every case support HEDIS documentation requirements.
Elderly patient drug regimen reviews align with high-risk medication monitoring in Medicare Star measures.
Aegis reviews support closure of care gaps, contributing to quality bonus payments for MA plans.
More precise diagnostic coding supports accurate risk adjustment, directly affecting plan reimbursement.
Regulatory direction requires clinician involvement with respect to interpretation. Aegis consultations adhere to the FDA Standard.
Every consultation is reviewed by a clinical pharmacist and approved by a board-certified molecular pathologist. We generate data supporting medical necessity for every case. Our billing methodology uses standard AMA-recognized pathology consultation and principal care management codes. Full compliance documentation, HIPAA information, and regulatory alignment detail are all available on our compliance page.
We are available to walk your team through our clinical model, billing methodology, and documentation standards. Whether this is your first time seeing an Aegis claim or you are evaluating a deeper relationship, the conversation starts the same way.
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Aegis bills your plan directly under pathology consultation codes CPT 80503 through 80506 or principal care management (PCM) codes. The pathology consultation codes are not common, because few pathologists specialize in molecular test interpretation. The codes, services, and billing methodology are all standard and AMA-recognized.
When a physician has precise, patient-specific drug selection guidance before writing the prescription, they get the treatment right the first time. This reduces the trial-and-error cycle that drives follow-up visits, adverse drug events, ER utilization, and hospital readmissions. Aegis consultations cost a fraction of any one of those downstream events.
Medical necessity documentation proves a test was clinically justified, the consultation was warranted, and the treatment recommendations were individualized. Aegis generates data to support this documentation during consultations. It provides audit-ready proof for your claims team.
