- 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 |
Get the Free JH Compliance Checklist]
Novitas Solutions does not participate in the MolDX program for JH. Labs billing molecular diagnostic tests, CPT codes in the 81XXX range, or most PLA codes do not need a Palmetto GBA DEX Z-Code to submit those claims; they bill under standard CPT/ICD-10 coding per the applicable LCD instead.
Novitas applies LCD L34419 — Molecular Pathology Procedures — as a standard (non-MolDX) LCD in JH. Texas’s biotech corridor has significant molecular lab presence; labs must validate ICD-10 linkage per test but do not need a Palmetto Z-Code. Confirm current LCD text through the Medicare Coverage Database.
| LCD | Coverage Area | Key Requirement |
|---|---|---|
| L34419 | Molecular Pathology Procedures | Standard (non-MolDX) LCD. Texas's biotech corridor has significant molecular lab presence; labs must validate ICD-10 linkage per test but do not need a Palmetto Z-Code. |
| L34752 | Urine Drug Testing | The most scrutinized LCD in JH. Novitas requires a written drug testing protocol per patient, physician attestation of medical necessity, frequency consistent with protocol, and specific ICD-10 diagnosis codes. |
| L35062 | Glycated Hemoglobin (HbA1c) | Standard quarterly policy. Texas has high diabetes prevalence — HbA1c frequency management is operationally important. |
| L35396 | Tumor Markers | Standard policy with active enforcement in the Texas oncology lab market. |
| L35095 | Vitamin D Assay | Documentation required. Louisiana and Mississippi rural populations create specific access and documentation challenges. |
| Test | CPT | Frequency Limit |
|---|---|---|
| Urine Drug Screen, presumptive | 80305-80307 | Per written clinical protocol; active review of labs billing more than monthly per patient without documented justification |
| Definitive Drug Testing | G0480-G0483 | More than 12 tests per year per patient triggers medical necessity review |
| HbA1c | 83036 | Quarterly for stable diabetics; monthly with documented treatment changes |
| Tumor markers (general) | 82378/86304/etc. | Quarterly for active treatment; per-clinical-context for surveillance |
| Molecular testing | 81XXX range | Standard LCD frequency limits apply — no Z-Code coverage terms since JH is not a MolDX jurisdiction |
Urine drug testing, both presumptive and definitive, the single largest review category.
Genetic testing ICD-10 linkage under the standard molecular pathology LCD.
Tumor markers in oncology-adjacent labs, particularly in the Texas market.
| Area | Requirement |
|---|---|
| Provider Enrollment | Submit CMS-855B to Novitas JH Provider Enrollment. Given JH's compliance scrutiny, ensure all enrollment information is current — discrepancies trigger pre-payment reviews. |
| ABN Requirements | ABN mandatory for any test with frequency or coverage limitations. Novitas JH has published specific ABN guidance for drug testing that differs from standard CMS guidance. |
| CLFS / Fee Schedule | The Texas lab market is highly competitive — verify Novitas JH remittances match CLFS rates. Systematic underpayment by payers is a revenue issue in this market. |
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Claims checked against your MAC's local coverage rules before submission.
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No. Novitas Solutions does not participate in the MolDX program for JH. Labs billing molecular diagnostic tests in the 81XXX range or most PLA codes bill under standard CPT/ICD-10 coding per LCD L34419 — no Palmetto GBA DEX Z-Code is required or accepted.
It's billed with standard CPT/ICD-10 coding under LCD L34419, with ICD-10 linkage validated per test. No Z-Code applies.
Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas. Novitas processes JH claims through the Novitasphere portal.
Texas has one of the largest independent lab markets in the country and a well-documented history of toxicology billing fraud enforcement. JH is consistently among the most active TPE jurisdictions nationally, with urine drug testing as the top scrutiny area.
Quarterly for stable diabetic patients. More frequent billing needs documentation of a treatment change or new diagnosis.
CMS-855B, submitted to Novitas JH Provider Enrollment. Given the jurisdiction's compliance scrutiny, keep enrollment information current to avoid triggering pre-payment reviews.
