This policy confirms ënon-coverage’ for all molecular diagnostic tests (MDT) that are not explicitly covered by a National Coverage Determination (NCD), a Local Coverage Determination (LCD), a coverage article published by Palmetto and excluded per MolDx Exempt Tests published on the Palmetto GBA website and excluded per MolDx Exempt Tests published on the Palmetto GBA website. This policy pertains to CPT/HCPCS Codes 83890-83914, 84999, 85999, 86849, 87999, 88371-88380, 88384-88386. The policy takes effect 5/7/2012.

Palmetto GBA

Medicare Part A and Part B MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.