Laboratory Test Codes Subject to Date of Service Exception (Updated 04/02/2020)

For purposes of the laboratory DOS policy exception in 42 CFR 414.510(b)(5), unlisted multianalyte assay with algorithmic analysis as described by HCPCS code 81599 pertains to DecisionDx-Melanoma only. DecisionDx-Melanoma is currently described by HCPCS code 81599 and identifier ZB1D4.

*In the case of a molecular pathology test or a test designated by CMS as an ADLT under paragraph (1) of the definition of advanced diagnostic laboratory test in 42 CFR 414.502, the DOS must be the date the test was performed only if: (1)The test was performed following a hospital outpatient’s discharge from the hospital outpatient department; (2) The specimen was collected from a hospital outpatient during an encounter (as both are defined in 42 CFR 410.2); (3) It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter; (4) The results of the test do not guide treatment provided during the hospital outpatient encounter; and (5) The test was reasonable and medically necessary for the treatment of an illness.

Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Clinical-Lab-DOS-Policy