Molecular Diagnostic Services

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 MolDX Molecular Test Registration and Claims Submission

View MolDX: Molecular Test Registration Requirement for Hospital Laboratories

View the Molecular Diagnostic Program (MolDX®) Manual

View the DEX® registry

Claim Submission Reminders

  • Submit only one DEX Z-Code® identifier per CPT that requires one
  • Submit DEX Z-Code® identifier in Loop 2400/SV101-7
  • If no DEX Z-Code® identifier is submitted, CPT will deny unprocessable
  • Do not submit any other characters or test names. Doing so will slow claims processing and possibly cause incorrect denials
  • NOTE: Number "0" and alpha letter "O" look very similar, check closely

Noridian’s MolDX LCDs and MolDX Articles

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

Active MolDX Billing and Coding Articles and Educational Articles - View all active MolDX Billing and Coding and Educational Articles

Contractor Advisory Committee (CAC) - View the CAC related information

Proposed MolDX LCDs - View all proposed MolDX LCDs

MolDX Open Public Meetings - View all scheduled and prior MolDX Open Public Meetings

Responsibilities

MolDX Contractor

  • Determinations regarding coverage
  • Pricing
  • Coordinates/communicates with the DEX Diagnostic Exchange test identification and policy management solution that connects payers and labs to bring clarity to MDx testing
  • Coordination/communication with Noridian on all claims processing guidelines

Noridian

  • Implement MolDX guidelines in cooperation with MolDX contractor
  • Process claims using MolDX guidelines
  • Conduct Appeals/Reopenings for claims processing for Noridian providers

Providers in Noridian's Jurisdictions

  • 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
Last Updated Nov 26 , 2024