- 4009 Hackney Springs Ln, Sachse, TX 75048
| STATES / TERRITORIES | PHONE · PORTAL | CLAIM VOLUME | BENEFICIARIES |
|---|---|---|---|
|
1-855-252-8782 · Novitasphere JL | ~200 million claims/year | ~3.4 million Medicare FFS |
JE is a MolDX jurisdiction. Any lab billing molecular diagnostic tests, CPT codes in the 81XXX range, or most PLA codes needs an active DEX Z-Code from Palmetto GBA’s DEX platform (dexzcodes.com) registered before those claims go out the door.
Noridian applies LCD L35025 — MolDX: Molecular Diagnostic Tests (MDT) — in JE. Labs must complete a Test Coverage Review (TCR) at dexzcodes.com for each molecular test they offer before billing. Confirm current LCD text through the Medicare Coverage Database.
Claims without a valid Z-Code are denied automatically, with no manual override at the claims level. This applies to hereditary cancer panels, pharmacogenomics, NGS, BRCA, Lynch syndrome, and most 81XXX-range tests billed in California, Hawaii, Nevada, and the Pacific territories.
| LCD | Coverage Area | Key Requirement |
|---|---|---|
| L35025 | MolDX: Molecular Diagnostic Tests (MDT) | Requires a DEX Z-Code from Palmetto GBA before billing any molecular diagnostic test. Labs must complete a Test Coverage Review for each molecular test they offer. |
| L35062 | Glycated Hemoglobin (HbA1c) | Quarterly for stable diabetics. California's large diabetic population makes frequency monitoring essential. |
| L35095 | Vitamin D Assay | Documentation required; Noridian JE has issued additional guidance articles restricting coverage to specific clinical contexts. |
| L34419 | Tumor Markers | PSA, CEA, CA-125, CA 19-9, AFP with specific ICD-10 coverage requirements. California's oncology volume makes this high-stakes. |
| L35099 | Non-Covered Lab Services | ABN protocol required. Noridian JE has been active in pre-payment reviews for labs with high non-covered claim rates. |
| Test | CPT | Frequency Limit |
|---|---|---|
| HbA1c | 83036 | Quarterly for stable diabetics; monthly for newly diagnosed or significant treatment change |
| Vitamin D | 82306 | Annual; therapeutic monitoring with documented deficiency treatment |
| PSA | 84153 | Annual for monitoring known prostate cancer |
| Tumor markers (general) | 82378/86304/etc. | Quarterly for active treatment monitoring; less frequent for surveillance |
| Drug Testing (definitive) | G0480-G0483 | Per clinical protocol; scrutiny elevated for labs billing more than monthly definitive testing |
Molecular diagnostics — MolDX compliance and Z-Code currency across California’s dense biotech testing market.
Tumor markers — ICD-10 linkage in California’s large oncology-adjacent lab population.
Toxicology — California’s large pain management and substance use treatment market drives drug testing scrutiny.
| Area | Requirement |
|---|---|
| Provider Enrollment | CMS-855B for independent labs in California, Hawaii, and Nevada. Noridian's enrollment unit in Fargo, ND processes all JE enrollments. Allow 45-90 days. |
| ABN Requirements | Standard CMS-R-131. Noridian JE has published specific ABN guidance for molecular testing — required before any molecular test without a confirmed Z-Code. |
| CLFS / Fee Schedule | California's large lab market means CLFS rate disputes are common — audit JE-specific contractual adjustment rates annually. |
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Yes. JE, administered by Noridian Healthcare Solutions, is a MolDX jurisdiction. Labs billing molecular diagnostic tests in the 81XXX range or most PLA codes must hold an active DEX Z-Code from Palmetto GBA before submitting claims.
The claim is denied automatically. There's no manual override at the claims level, which is why Z-Code registration has to happen before billing.
California, Hawaii, Nevada, American Samoa, Guam, and the Northern Mariana Islands.
Quarterly for stable diabetic patients under LCD L35062. More frequent billing needs documentation of a significant treatment change or new diagnosis.
California alone has one of the largest Medicare populations in the country, and JE also covers Hawaii, Nevada, and several Pacific territories — making it the highest-volume A/B MAC jurisdiction nationally.
CMS-855B, submitted to Noridian's enrollment unit in Fargo, ND. Allow 45-90 days for processing.
