Envisia Genomic Classifier test, which uses RNA sequencing and machine learning technology to diagnose idiopathic pulmonary fibrosis.

The Wisconsin Physicians Service Insurance Corporation posted its draft LCD online and Veracyte said it anticipates that three other Medicare Administrative Contractors — CGS, Noridian Health Solutions, and Palmetto GBA — would follow suit.

INDUSTRY NEWS TAGS:MolDX Palmetto GBA Veracyte

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The following A/B MAC LCD(s) were revised:

INDUSTRY NEWS TAGS:MolDX Palmetto GBA

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The following A/B MAC LCDs were revised:

INDUSTRY NEWS TAGS:Palmetto GBA

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The following A/B MAC LCDs were revised:

  • MolDX: Molecular Diagnostic Tests (MDT) L35025
  • In Vitro Chemosensitivity & Chemoresistance Assays L34554
  • MolDX: Genetic Testing for Lynch Syndrome L35024

The following A/B MAC LCDs began their notice period July 26, 2018. The notice period will end September 9, 2018. Any revisions made will become effective September 10, 2018.

INDUSTRY NEWS TAGS:MolDX Palmetto GBA

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Part A providers billing for molecular services have been advised to register for a DEX Z-Code identifier for each molecular test for which they bill Medicare. If a DEX Z-code has not already been obtained, go to DEX Diagnostics Exchange and select 'register your organization.' Effective December 1, 2017, claims submitted without a Z-Code will be rejected.

INDUSTRY NEWS TAGS:MolDX Jurisdictions JE A/B MAC JE A/B MAC California JE A/B MAC Nevada JE A/B MAC Hawaii JE A/B MAC Guam JE A/B MAC American Samoa JE A/B MAC Northern Marianas Noridian Healthcare Solutions JF A/B MAC JF A/B MAC Oregon JF A/B MAC Washington JF A/B MAC Idaho JF A/B MAC Utah JF A/B MAC Montana JF A/B MAC Wyoming JF A/B MAC Nevada JF A/B MAC Arizona JF A/B MAC North Dakota JF A/B MAC South Dakota JF A/B MAC Alaska JF A/B MAC Aleutian Islands JM A/B MAC JM A/B MAC North Carolina JM A/B MAC South Carolina JM A/B MAC Virginia JM A/B MAC West Virginia Palmetto GBA J5 A/B MAC J5 A/B MAC Iowa J5 A/B MAC Kansas J5 A/B MAC Missouri J5 A/B MAC Nebraska WPS Government Health Administrators J8 A/B MAC J8 A/B MAC Michigan J8 A/B MAC Indiana J15 A/B MAC J15 A/B MAC Ohio J15 A/B MAC Kentucky CGS Administrators MAC JJ Alabama MAC JJ Georgia MAC JJ Tennessee

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The MolDX team welcomes the states of Georgia, Tennessee, and Alabama to the MolDX program and to Palmetto GBA. Medicare Part A and Part B providers in the Palmetto GBA Jurisdiction J will be are required to register all molecular tests with the Diagnostics ExchangeTM (DEX), an online test registry. DEX Diagnostics ExchangeTM will assign a unique Z-Code identifier to each molecular test. After the registration and application processes have been completed, the MolDX team will access the registry information to determine if a test meets the Medicare criteria for coverage.

INDUSTRY NEWS TAGS:MolDX Jurisdictions JE A/B MAC JE A/B MAC California JE A/B MAC Nevada JE A/B MAC Hawaii JE A/B MAC Guam JE A/B MAC American Samoa JE A/B MAC Northern Marianas Noridian Healthcare Solutions JF A/B MAC JF A/B MAC Oregon JF A/B MAC Washington JF A/B MAC Idaho JF A/B MAC Utah JF A/B MAC Montana JF A/B MAC Wyoming JF A/B MAC Nevada JF A/B MAC Arizona JF A/B MAC North Dakota JF A/B MAC South Dakota JF A/B MAC Alaska JF A/B MAC Aleutian Islands JM A/B MAC JM A/B MAC North Carolina JM A/B MAC South Carolina JM A/B MAC Virginia JM A/B MAC West Virginia Palmetto GBA J5 A/B MAC J5 A/B MAC Iowa J5 A/B MAC Kansas J5 A/B MAC Missouri J5 A/B MAC Nebraska WPS Government Health Administrators J8 A/B MAC J8 A/B MAC Michigan J8 A/B MAC Indiana J15 A/B MAC J15 A/B MAC Ohio J15 A/B MAC Kentucky CGS Administrators MAC JJ Alabama MAC JJ Georgia MAC JJ Tennessee

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The objective of this document is to describe the process that Palmetto GBA uses to determine coverage, coding, and pricing for molecular diagnostic tests and other molecular pathology services administered through the Molecular Diagnostic Services (MolDX®) Program.

INDUSTRY NEWS TAGS:MolDX Jurisdictions JE A/B MAC California JE A/B MAC Nevada JE A/B MAC Hawaii JE A/B MAC Guam JE A/B MAC American Samoa JE A/B MAC Northern Marianas Noridian Healthcare Solutions JF A/B MAC Oregon JF A/B MAC Washington JF A/B MAC Idaho JF A/B MAC Utah JF A/B MAC Montana JF A/B MAC Wyoming JF A/B MAC Nevada JF A/B MAC Arizona JF A/B MAC North Dakota JF A/B MAC South Dakota JF A/B MAC Alaska JF A/B MAC Aleutian Islands JM A/B MAC North Carolina JM A/B MAC South Carolina JM A/B MAC Virginia JM A/B MAC West Virginia Palmetto GBA J5 A/B MAC Iowa J5 A/B MAC KansasJ5 A/B MAC J5 A/B MAC Missouri J5 A/B MAC Nebraska WPS Government Health Administrators J8 A/B MAC Michigan J8 A/B MAC Indiana J15 A/B MAC Ohio.J15 A/B MAC Kentucky CGS Administrators LLC

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Palmetto GBA uses data-driven pattern detection techniques communicated through 'smart edits'. These will appear on claim rejection reports as Palmetto GBA/Railroad Medicare deploys 'ACE' to the electronic claim submission process for professional claims. 'ACE', an abbreviation for 'Advanced Clinical Editing System', returns pre-adjudicated messaging through claim acknowledgement transaction reports sent by your clearinghouse based on the Medicare 277CA.

INDUSTRY NEWS TAGS:Palmetto GBA MAC JM North Carolina MAC JM South Carolina MAC JM Virginia MAC JM West Virginia

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Palmetto GBA has been notified of an issue where some ranges of ICD-10 diagnosis codes were not read correctly by the system when the new ICD 10 file was loaded. As a result, some claims were incorrectly denied when the claims contained a valid diagnosis. Additionally, some claims may have paid when they contained a diagnosis code that was not valid. The system issue impacted a small number of claims processed on August 25, 2017. The system self-corrected on August 26, 2017 during the next cycle. Palmetto GBA will perform adjustments on affected claims.

INDUSTRY NEWS TAGS:Palmetto GBA MAC JM North Carolina MAC JM South Carolina MAC JM Virginia MAC JM West Virginia

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On October 2, 2017 Medicare Administrative Contractors (MACs) began using Group Code OA (Other Adjustment) and Claim Adjustment Reason Code (CARC) 209 (“Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer.

INDUSTRY NEWS TAGS:Palmetto GBA MAC JM North Carolina MAC JM South Carolina MAC JM Virginia MAC JM West Virginia

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