May 2012 Newsletter
Updates to the MolDx Program
After several delays and much controversy, Palmetto GBA officially implemented its Molecular Diagnostic Services Program (MolDx) on May 7, 2012, but with a grace period of several weeks. Until June 1, providers will only receive information notices for claims that do not have the required MolDx test identifier, either a Palmetto Test Identifier (PTI) or a McKesson Z-Code™. After June 1, however, claims for molecular diagnostic tests will be rejected without the required identifier (unless Palmetto GBA announces another delay).
MolDx is a Medicare program that was developed to identify and establish coverage and reimbursement for molecular diagnostic tests, typically reported on claims as a series of “stacked,” methodology-based CPT codes. The MolDx program is currently limited to Jurisdiction 1 A/B MAC (covering California, Hawaii, Nevada, Pacific Islands), but there is industry discussion about extending it or a similar program to other MACs and private payers. At the Forum for Payers on Personalized Medicine this spring, the chief medical officer of Harvard Pilgrim Healthcare, Michael Sherman, and the Second Vice President of pharmacy strategies at Trustmark Insurance, Thomas Johnston, discussed their companies’ plans for systems to better identify, track, and make reimbursement decisions for molecular tests. Both are considering working with an outside vendor, such as McKesson, that already has the framework for managing molecular and genetic tests. Details have not been released, but further information is expected by the end of this year.
Quadax is closely monitoring developments in this area because new requirements will impact many of our laboratory clients. Programming enhancements to our HARP software were implemented in April to allow the MolDx test identifier to be recorded for patients undergoing molecular diagnostic procedures and pass them on claims. Interfaces were customized by client to enable the electronic loading of molecular test codes directly into HARP. Other improvements to our systems are in the works. The release notes will include any updates you need to know about this evolving field. As always, address questions or concerns about your molecular test claims to your account representative, who is available to discuss them with you.