- 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 JJ Compliance Checklist]
JJ is a MolDX jurisdiction, and Palmetto GBA is the program’s originating administrator. 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.
Claims without a valid Z-Code are denied automatically, with no manual override at the claims level. Because Palmetto originates MolDX coverage decisions nationally, keeping your Z-Code registrations current here has consequences well beyond JJ’s three states.
| LCD | Coverage Area | Key Requirement |
|---|---|---|
| L35025 | MolDX: Molecular Diagnostic Tests (MDT) | Palmetto is the originating MAC for all MolDX coverage decisions, including hereditary cancer panels, pharmacogenomics, somatic tumor profiling, NGS, BRCA/BRCA2, Lynch syndrome, and PLA-coded tests. |
| L35062 | Glycated Hemoglobin (HbA1c) | Standard quarterly policy. Georgia and Alabama have high diabetes prevalence. |
| L34752 | Urine Drug Testing | Active LCD. Tennessee's opioid crisis has made drug testing billing a significant compliance area in JJ. |
| L35396 | Tumor Markers | Active enforcement. Georgia's oncology market is growing — tumor marker billing is a significant revenue and compliance area. |
| L35095 | Vitamin D Assay | Standard documentation requirements. |
| Test | CPT | Frequency Limit |
|---|---|---|
| Molecular tests (Z-Code covered) | 81XXX range | Frequency is specified in each MolDX Z-Code coverage determination — varies by test and clinical context |
| HbA1c | 83036 | Standard quarterly framework |
| Drug Testing | 80305-80307 / G0480-G0483 | Per written clinical protocol with documented medical necessity |
| Tumor markers (general) | 82378/86304/etc. | Standard quarterly/surveillance framework |
Molecular diagnostics — MolDX compliance, given Palmetto’s direct oversight of the national program from this jurisdiction.
Drug testing — Tennessee’s opioid crisis has made this a significant, ongoing focus area.
| Area | Requirement |
|---|---|
| Provider Enrollment | CMS-855B to the Palmetto GBA Provider Enrollment unit in Columbia, SC. |
| ABN Requirements | Critical for molecular testing — Palmetto requires ABN documentation for any molecular test without confirmed Z-Code coverage or where the coverage determination has expired. |
| CLFS / Fee Schedule | Palmetto GBA is proactive in publishing CLFS impact notices given the molecular testing market in its jurisdictions. |
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Yes, and Palmetto GBA is the program's originating administrator; Palmetto issues the DEX Z-Codes used across all seven MolDX jurisdictions. Labs billing molecular tests in JJ must hold an active Z-Code 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.
Alabama, Georgia, and Tennessee. Palmetto also administers JM (North Carolina, South Carolina, Virginia, West Virginia) through the same provider portal.
Palmetto's MolDX program issues the Z-Codes used across all seven MolDX jurisdictions; JE, JF, J5, J8, J15, JJ, and JM, so any lab billing molecular tests in those jurisdictions has a direct relationship with Palmetto through dexzcodes.com, regardless of physical location.
Quarterly for stable diabetic patients. More frequent billing needs documentation of a treatment change or new diagnosis.
CMS-855B, submitted to the Palmetto GBA Provider Enrollment unit in Columbia, SC.
