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| STATES / TERRITORIES | PHONE · PORTAL | CLAIM VOLUME | BENEFICIARIES |
|---|---|---|---|
|
1-855-252-8782 · Novitasphere JL | ~200 million claims/year | ~3.4 million Medicare FFS |
| LCD | Coverage Area | Key Requirement |
|---|---|---|
| L34419 | Tumor Markers | Active LCD. Pennsylvania and New Jersey oncology volumes are significant. |
| L35062 | Glycated Hemoglobin (HbA1c) | Standard quarterly framework. |
| L35095 | Vitamin D Assay | Standard documentation requirements. |
| L34752 | Urine Drug Testing | Active LCD with medical necessity requirements. New Jersey and Pennsylvania's pain management market is active. |
| L35099 | Non-Covered Lab Services | ABN protocols required; Novitas JL actively monitors labs with elevated non-covered billing. |
| Test | CPT | Frequency Limit |
|---|---|---|
| HbA1c | 83036 | Standard quarterly |
| Vitamin D | 82306 | Annual; therapeutic monitoring with documentation |
| Tumor markers (general) | 82378/86304/etc. | Standard quarterly/surveillance framework |
| Drug Testing | 80305-80307 / G0480-G0483 | Per written clinical protocol |
Clinical chemistry panel miscoding — the same panel-vs-component billing pattern seen across most MACs.
Vitamin D testing documentation, without the ICD-10 support the LCD requires.
Tumor marker ICD-10 linkage in the Pennsylvania and New Jersey oncology market.
| Area | Requirement |
|---|---|
| Provider Enrollment | CMS-855B for independent labs. Submit to Novitas JL Provider Enrollment in Mechanicsburg, PA. |
| ABN Requirements | Standard CMS-R-131, with Novitas JL ABN guidance available on novitas-solutions.com. |
| CLFS / Fee Schedule | JL covers significant hospital outpatient lab volume — OPPS packaging rules apply for hospital-based labs, which differs from CLFS treatment for independent labs. |
Labs lose revenue to preventable denials; miscoded panels, missed modifiers, payer-specific mismatches. TransLabs built its billing process around what labs actually need to get paid, coast to coast. Start with a complimentary claims audit. We’ll review your CPT/HCPCS coding, test methodology, and denial trends to show you exactly what’s recoverable.
Claims checked against your MAC's local coverage rules before submission.
Medicaid and commercial prior-auth rules built into your workflow, not discovered after denial.
Appeals strategy built from denial data across all 50 states.
A dedicated billing specialist; never a shared call queue.
Live in 24 hours. No contracts. No upfront fees.
No. Novitas Solutions does not participate in the MolDX program for JL — the same as its sister jurisdiction JH. Labs bill molecular diagnostic tests using standard CPT/ICD-10 coding under the applicable LCD; no Z-Code is required.
It's billed with standard CPT/ICD-10 coding under the applicable non-MolDX LCD. No Z-Code applies.
Delaware, the District of Columbia, Maryland, New Jersey, and Pennsylvania.
Standard quarterly framework for stable diabetic patients; monthly billing needs documentation of a treatment change or new diagnosis.
Federal employee and contractor patients require careful Medicare coordination, and research-derived tests may not be separately billable; a pattern that doesn't show up the same way in JL's other states.
CMS-855B, submitted to Novitas JL Provider Enrollment in Mechanicsburg, PA.
