We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
To determine coverage, a Technical Assessment (TA) is required for molecular assays that are laboratory developed tests (LDT), include Next Generation Sequencing (NGS) technology, employ new or novel technology, or have undefined or unproven clinical utility. During the TA period, developers should suspend claims submission for the test service. Before submitting a TA, labs must register a test and obtain a unique identifier through the DEXTM Diagnostics Exchange.
In order to receive favorable review results, the assay must demonstrate clinical utility (CU), fulfill the CMS "reasonable and necessary" criteria, and meet analytical and clinical validity (AV/CV) standards. In addition to these categories of evidence, CMS has directed MolDX to follow the ACCE criteria developed by the Centers for Disease Control and Prevention. For more information on the ACCE model, view cdc.gov/ACCE.
In order to reduce delays and unfavorable determinations, please ensure that the TA submission is complete. Select the link below for specific instructions on how to submit all required documentation for a TA.
Technical Assessment Submission Checklist (PDF, 4 MB)
Technical Assessments should be sent to MolDX@PalmettoGBA.com.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article try to revise or expand it. In the meantime we recommend you:
Last Updated: 7/01/2020
Applies to: MolDx
Article Topics: Appeals, Redeterminations, and PTANs