- 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 JK Compliance Checklist
NGS applies LCD L34552 — Molecular Pathology — as a standard (non-MolDX) LCD in JK. Labs must still validate ICD-10 linkage per test but do NOT need a Palmetto DEX Z-Code. Confirm current LCD text through the Medicare Coverage Database.
Because JK skips Z-Code registration, the real compliance exposure sits with flow cytometry and anatomic pathology coding — number of markers per specimen, reporting requirements, and TC/PC modifier application are the details that actually drive denials in this jurisdiction.
| LCD | Coverage Area | Key Requirement |
|---|---|---|
| L34552 | Molecular Pathology | Standard (non-MolDX) LCD. Labs must still validate ICD-10 linkage per test but do NOT need a Palmetto DEX Z-Code. |
| L35062 | Glycated Hemoglobin (HbA1c) | Standard quarterly policy. |
| L35396 | Tumor Markers | Active enforcement given the oncology center concentration in Boston and New York. |
| L34419 | Flow Cytometry (88184-88189) | Specific coverage criteria for hematologic malignancy evaluation. Number of markers per specimen, reporting requirements, and TC/PC modifier application are key compliance areas. |
| L35095 | Vitamin D Assay | Standard documentation requirements. New England's limited sun exposure population has high Vitamin D testing demand. |
| Test | CPT | Frequency Limit |
|---|---|---|
| HbA1c | 83036 | Standard quarterly/monthly framework |
| Flow Cytometry | 88184-88189 | Per episode of care for malignancy evaluation; not covered as routine surveillance without documented clinical change |
| Tumor markers (general) | 82378/86304/etc. | Standard quarterly/surveillance framework |
| Vitamin D | 82306 | Annual; therapeutic monitoring exception |
Tumor marker ICD-10 documentation, given the concentration of oncology centers in Boston and New York.
Flow cytometry reporting compliance — marker counts and reporting requirements under L34419.
Esoteric lab test medical necessity, reflecting the region’s academic medical center test mix.
| Area | Requirement |
|---|---|
| Provider Enrollment | CMS-855B for independent labs. NGS's enrollment operation in Indianapolis, IN handles JK applications. |
| ABN Requirements | Standard CMS-R-131. Specific NGS guidance for molecular and esoteric testing ABN procedures is available on ngsmedicare.com. |
| CLFS / Fee Schedule | New England academic medical center labs should monitor PLA code additions to the CLFS annually. |
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No. NGS does not participate in the MolDX program for JK. Labs billing molecular diagnostic tests in the 81XXX range or most PLA codes bill under standard CPT/ICD-10 coding per LCD L34552; no Palmetto GBA DEX Z-Code is required or accepted.
It's billed with standard CPT/ICD-10 coding under LCD L34552, with ICD-10 linkage validated per test. No Z-Code applies.
Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont. NGS processes JK (and J6) claims through the iCS portal.
LCD L34419 sets specific coverage criteria for hematologic malignancy evaluation, including the number of markers per specimen, reporting requirements, and correct TC/PC modifier application, all frequent TPE focus areas in this jurisdiction.
Standard quarterly framework for stable diabetic patients; monthly billing needs documentation of a treatment change or new diagnosis.
CMS-855B, submitted to NGS's enrollment operation in Indianapolis, IN.
