Downloadable Forms

Here are the necessary forms to process our biomarker tests. 

SYNTap® Biomarker Test Specification Sheet

SYNTap® Biomarker Test Performance Characteristics Summary

SYNTap® Biomarker Test Requisition Form

Advance Beneficiary Notice (Medicare Only)

Advance Beneficiary Notice (Medicaid & Medicare)

SYNTap® Test
Performance Summary

Please enter your information to download the SYNTap Test Performance Summary

SYNTap Performance Summary

ATTENTION!!

Amprion has some important news we need to share with you!

To improve patient access to the SYNTap® biomarker test (CSF), Amprion is reducing the self-pay price for tests with service dates on or after July 1, 2023.

Old self-pay price: $1500.00. New self-pay price: $995.00

Effective July 1, 2023, there is a New ABN (Advanced Beneficiary Notification) form for use when ordering the SYNTap® biomarker test (CSF) for patients on Medicare. Order Process

CPT/PLA – The SYNTap® test has been issued a dedicated PLA code to be used when billing: 0393U
 
We have applied to be a medicare provider and will soon be able to courtesy bill Medicare for your patients.