CMS Directs Expansion of the Molecular Diagnostic Services (MolDx) Program

CMS has directed Palmetto GBA to expand the J1 Molecular Diagnostic Services Program (MolDx) to identify and establish coverage and reimbursement for molecular diagnostic tests. The MolDx program is powered by the McKesson Diagnostics ExchangeTM to enable standardized, time bound test registration and coverage determination processes. The MolDx program will assign a unique McKesson Z-CodeTM (Z-Code) for each unique test to measure utilization, apply coverage determinations, and facilitate reimbursement. Palmetto GBA will use the Z-Code to identify the billed test, determine reasonable and necessary services and apply appropriate reimbursement without the burden of additional documentation requirements for each claim. Effective November 14, 2011, laboratory providers can request Z-Codes via a downloaded template. In January, 2012, the McKesson Diagnostics ExchangeTM Registry Module will be available online for laboratory providers to access their existing Z-Code assignments and register new tests. The MolDx program will also facilitate the coverage determination process by implementing a formal, time bound, technology enabled mechanism for coverage determination. Effective March 1, 2012, to request a coverage determination, laboratory providers will submit, per the MolDx Program, required test information and supporting evidence to the McKesson Diagnostics ExchangeTM Test Assessment Module. Source: Palmetto J1 A/B MAC – California, Nevada, Hawaii and the US Pacific Territories of Guam, American Samoa and the Northern Marianas