Palmetto GBA® Molecular Diagnostic Services (MolDx) Program

Frequently Asked Questions (FAQs)

Is ARUP Laboratories participating in Palmetto GBA’s Molecular Diagnostic Services (MolDx) Program?

  • Yes! ARUP Laboratories is participating in the MolDx Program. All hospital, private, and reference laboratories that perform molecular diagnostic testing and bill Medicare in Palmetto’s coverage areas are affected by this program.

What is Palmetto GBA, and what region does it cover?

  • Palmetto GBA is a national third-party administrator of Medicare health insurance programs for the Centers for Medicare & Medicaid Services.
  • The program covers all claims for A/B MAC Jurisdiction 1, which covers California, Nevada, Hawaii, and the U.S. Pacific territories of Guam, American Samoa, and the Northern Mariana Islands.

What is the purpose of the MolDx Program?

  • The purpose of the MolDx Program is to identify and pre-establish coverage and reimbursement codes for molecular diagnostic tests that were previously reported with CPT methodology-based “stacking codes.”
  • Palmetto requires a McKesson Z-Code or a Palmetto Test Indicator (PTI) code to identify molecular diagnostic tests and to determine coverage and reimbursement. Such codes will help payers identify the specific analyte tested and will reduce inefficiencies, since coverage and reimbursement will be predetermined.
  • Applications are required for CPT codes 83890–83914, 88384–88386, and the “pathology/laboratory not otherwise classified” (NOC) codes.

Has ARUP applied to the MolDx Program?

  • Yes! ARUP has submitted Palmetto Test Identifier (PTI) code applications for all affected ARUP test codes. As soon as the PTI codes are received from Palmetto, they will be posted on the ARUP Laboratories website. They will also be included on invoices for our clients’ convenience.

What is the difference between a Z-Code and a PTI code?

  • The primary difference is that the Z-Code may be used to identify tests outside the Palmetto GBA MolDx Program, and information will be available through the McKesson Diagnostics Exchange™ public registry. Each MolDx test provider is required to submit an application to Palmetto for either Z-Codes or PTI codes. ARUP has opted to apply for PTI codes.

Are ARUP’s PTI codes available?

What are the important dates in the Palmetto MolDx Program implementation?

  • May 7, 2012: Claims for MolDx services will receive an informational notice that the required MolDx test identifier (PTI/Z-Code identifier) has not been submitted with the claim.
  • June 1, 2012: Claims for molecular diagnostic tests will only be considered when a Z-Code or a PTI code has been assigned to the test and is entered in the comment/narrative field of the MolDx registration form. If the Z-Code or PTI code is pending, or the laboratory is unable to update internal systems for claims submission, Palmetto GBA will accept a fax and a completed Palmetto GBA Test Identifier Application form with each claim.
  • Between June 1, 2012, and September 1, 2012: Claims can be submitted by fax using the Palmetto GBA Test Identifier (PTI) fax. Palmetto GBA will reject all claims for MolDx services that are submitted without the required MolDx test identifier (PTI/Z-Code identifier).
  • September 1, 2012: Palmetto will no longer accept claims via fax.

Are Palmetto codes and 2012 CPT codes related?

  • Not exactly. Throughout the United States, as of January 1, 2012, Medicare requests that Medicare claims for Molecular Pathology Procedures reflect both the existing CPT “stacked” test codes that are required for payment and the new single CPT test code that would be used for payment purposes if the new CPT test codes were active. ARUP will continue to invoice our clients with the existing “stacking” codes; however, both the new single CPT test code and the existing CPT “stacking” codes are provided as a cross-walked document for reference. We will provide this information for clients who require the Palmetto PTI codes as well.

Where can I go for more information about the Palmetto codes?