Palmetto MoPath Claims Submission Guidelines

Because the MoPath Tier 2 CPT code descriptions do NOT identify the specific genes tested, laboratory providers that have not obtained a unique 5-digit ID through Palmetto GBA or McKesson Dex must provide additional information until an ID is obtained. As per the MolDx Program, claims submitted in J1 without a unique ID will be denied. Claims submitted in all other areas administered through Palmetto GBA should reference the “Required Text,” Column 3, to submit the information required for claim reimbursement. Column 3 “Required Text” lists key components needed to adjudicate the claim.

ï‚· J11 Part B: Effective for claims processed on and after July 1, 2013   (North Carolina, South Carolina, Virginia and West Virginia)

ï‚· J1 Part B: Effective for claims processed on and after January 1, 2013 (California, Hawaii and Nevada)

MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia; and MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.