TPMT Gene Analysis is a New Medi-Cal Benefit

  • Nov 15, 2018

Effective for dates of service on or after November 1, 2018, CPT-4 code 81335 (TPMT [thiopurine S-methyltransferase], gene analysis, common variants) is a Medi-Cal benefit. A Treatment Authorization Request (TAR) is required when billing for the gene analysis. The TAR must document that the patient is undergoing thiopurine therapy and that the patient has severe or prolonged myelosuppression. CPT...

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MolDX Local Coverage Determination - Notice Period

  • Nov 15, 2018

Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels L37713 began its notice period September 27, 2018. The notice period will end November 11, 2018. Any revisions made will become effective November 12, 2018.

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MolDX Local Coverage Determination (LCD) Update

  • Nov 15, 2018

The MolDX: Genomic Health Oncotype DX Prostate Cancer Assay L36153 A/B MAC Local Coverage Determination (LCD) was revised. 

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New LCD Process, LCD Reconsideration Process and Other Important Changes

  • Nov 14, 2018

The key parts of the New LCD Process are summarized 13.2.2.3 - New LCD Request Requirements (Rev: 829; Issued: 10-03-18; Effective: 10-03-18; Implementation: 01-08-19) Contractors shall consider New LCD Requests to be a complete, formal request if the following are met: • The request is in writing and can be sent to the MAC via e-mail, facsimile or written letter; • The request clearly...

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Baylor Gets $6.3M NCI Grant for Racial, Ethnic Cancer Disparities Work

  • Nov 14, 2018

The National Cancer Institute (NCI) has awarded $6.3 million to support researchers at Baylor College of Medicine in understanding the biological causes of racial and ethnic disparities in prostate and breast cancers.  Baylor will use the grant to establish the Minority Patient-derived xenograft Development and Trial Center (M-PDTC), which will gather experts in molecular biology, animal...

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Medical Policy Update

  • Nov 14, 2018

Botulinum Toxin (BT) Cardiovascular Magnetic Resonance (CMR) Computed Tomographic Angiography (CTA) and Magnetic Resonance Angiography (MRA) of the Head, Neck, Abdomen, Pelvis, and Lower Extremities Electromyography (EMG), Nerve Conduction Studies (NCS), and Other Electrodiagnostic (EDX) Related Services Hepatitis C First Generation Agents - Through Preferred Agent Hepatitis C Second...

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MolDX Molecular Test Registration and Claims Submission (M00148, V13)

  • Nov 14, 2018

Every molecular test billed by any laboratory or facility within MolDX and our Medicare-partner jurisdictions must obtain a Z-code for each molecular test prior to claim submission.  To access and obtain a DEX Z-codeTM identifier, follow these steps Go to the DEX Diagnostics ExchangeTM: https://app.dexzcodes.com   Select "Register My Organization" and follow the prompts,...

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UnitedHealthcare to Institute Site of Care Reviews for Certain Advanced Outpatient Imaging Procedures

  • Nov 14, 2018

Beginning with dates of service on or after Jan. 1, 2019, once prior authorization is requested for certain advanced outpatient imaging procedures (CT and MR) in accordance with its Outpatient Radiology Notification/Prior Authorization Protocol, UHC will review the site of care. UHC will not conduct site of care reviews if the procedure is planned to be performed in a outpatient freestanding...

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