The Molecular Diagnostic Services (MolDX) Program was developed by Palmetto GBA in 2011 to identify and establish coverage and reimbursement for molecular diagnostic tests. This program performs the following functions.

• Facilitates detailed and unique identification through registration of molecular diagnostic tests to facilitate claims processing and to track utilization.
• Establishes clinical utility expectations.
• Completes technical assessments of published test data to determine clinical utility and coverage.
• Establishes reimbursement.

View the MolDX Molecular Test Registration and Claims Submission [PDF]

View the MolDX: Molecular Test Registration Requirement for Hospital Laboratories [PDF]

View the Molecular Diagnostic Program (MolDX®) Manual [PDF]

Palmetto GBA currently administers the MolDX Program and all its information.

Active LCDs - View all active Local Coverage Determinations (LCDs)

Covered Tests - View MolDX LCDs and LCD Articles

Excluded Tests - View MolDx tests excluded from coverage

Draft LCDs - View all draft LCDs

Future LCDs - View all future LCDs

Claim Submission Reminders

• Submit only one Z-code per CPT that requires one
• Submit Z-code in Loop 2400/SV101-7
• If no Z-code is submitted, CPT will deny
• Do not submit any other characters or test names. Doing so will slow claims processing and possibly cause incorrect denials

Responsibilities

MolDX Contractor	Noridian	Providers in Noridian's Jurisdictions
Determinations regarding coverage Pricing Coordination with Change Healthcare to establish a unique identification numbers Coordination/communication with Noridian on all claims processing guidelines	Implement MolDX guidelines in cooperation with MolDX contractor Process claims using MolDX guidelines Conduct Appeals/Reopenings for claims processing for Noridian providers	Continue to send new test documentation in regards to coverage consideration to MolDX contractor Submit claims to Noridian after unique identifiers have been assigned Send policy/coverage questions to Palmetto at moldx@palmettogba.com Contact Noridian Provider Contact Center with claims processing questions Submit Reopening/Appeals requests to Noridian