Palmetto GBA Advice on Tier 1 & 2 Molecular Pathology Codes
January 1, 2013Live from the G2 Intelligence Molecular Coding and Billing Workshop
UPDATE! 01/25/2013 Cahaba first MAC to release pricing on molecular pathology codes: below what was expected.
January 24, 2013 – Palmetto GBA verifies that pricing for the Tier 1 molecular pathology codes are being loaded now. Pricing for the Tier 1 codes should be posted early next week. All valid claims should be paid within the next 30 days.
Palmetto states it is not pricing the Tier 2 codes right now so it can’t easily pay them. Palmetto will be able to process those tests that have MolDx identifiers. Other contractors will not have the same visibility so expect claims using these codes to be either rejected with requests for additional information, suspended for pricing or denied. Palmetto strongly recommends that Tier 2 codes be accompanied by test descriptors on the claim in addition to attached documentation providing service details. This would be similar to how NOC codes are handled.