Bulletin: December 6, 2011
MolDx Program
Laboratories providing molecular diagnostic tests must prepare for changes to how claims for their services are submitted and paid. In March 2012, Palmetto GBA is implementing the Molecular Diagnostic (MolDx) Services Program, which will require McKesson Z-Codes™ on claims to identify molecular diagnostic tests and also determine coverage and reimbursement. Z-Codes will be passed in the comment/narrative field on claims.
The impacted procedures or services, according to Palmetto, are ones that:
- Require/use more than one CPT code to identify the service
- Use the methodology-based 'stacking CPT codes' (83890-83914), micro-array CPT codes (88384-88386) and cytogenetic CPT codes (88230-88291)
- Use Pathology and Laboratory Not Otherwise Classified (NOC) codes
Initially, MolDx will affect only the J1 A/B MAC (including laboratory providers that bill J1 services performed by a lab that is not in J1), but it could be the template for other jurisdictions.
As of November 14, laboratories can apply for Z-Codes through Palmetto. The application process includes submitting supporting evidence for a coverage and reimbursement determination. Once a Z-Code is assigned, providers will not need to submit supporting documentation with each claim because coverage and payment are predetermined.
Effective March 1, 2012, claims for molecular diagnostic services will be rejected if they do not have a Z-Code.
Quadax is currently in the process of updating our applications to accept the new Z-Codes and pass them on claims. We will work with our clients to ensure compliance with the new requirements.