- 4009 Hackney Springs Ln, Sachse, TX 75048
| STATES / TERRITORIES | PHONE · PORTAL | CLAIM VOLUME | BENEFICIARIES |
|---|---|---|---|
| 1-855-696-0705 · Palmetto GBA Provider Portal | ~165 million claims/year | ~2.9 million Medicare FFS |
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| LCD | Coverage Area | Key Requirement |
|---|---|---|
| L35025 | MolDX: Molecular Diagnostic Tests (MDT) | Z-Code required for all molecular diagnostic tests. Same Palmetto DEX system as JJ — JM labs must obtain Z-Codes before billing molecular tests. |
| L34752 | Urine Drug Testing | Active LCD. West Virginia's opioid crisis has made drug testing compliance a top priority. Palmetto JM has issued specific guidance on drug testing medical necessity documentation. |
| L35062 | Glycated Hemoglobin (HbA1c) | Standard quarterly framework. |
| L35396 | Tumor Markers | Active enforcement. Duke and UNC oncology labs drive significant tumor marker billing. |
| L35095 | Vitamin D Assay | Standard documentation required. |
| Test | CPT | Frequency Limit |
|---|---|---|
| Drug Testing | 80305-80307 / G0480-G0483 | Per written clinical protocol; West Virginia-specific scrutiny on frequency and documentation |
| Molecular tests (Z-Code covered) | 81XXX range | Per MolDX Z-Code coverage terms |
| HbA1c | 83036 | Standard quarterly |
| Tumor markers (general) | 82378/86304/etc. | Standard quarterly/surveillance framework |
Drug testing — West Virginia’s opioid crisis context makes this the leading review category.
Molecular diagnostics — MolDX compliance, given JM’s co-administration role alongside JJ.
| Area | Requirement |
|---|---|
| Provider Enrollment | CMS-855B to Palmetto GBA Provider Enrollment in Columbia, SC. |
| ABN Requirements | Required for any molecular test without a confirmed Z-Code and for drug testing outside covered frequency. |
| CLFS / Fee Schedule | JM academic medical center labs should monitor PLA code additions alongside CLFS updates. |
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Yes. JM co-administers the MolDX program with JJ. 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.
North Carolina, South Carolina, Virginia, and West Virginia. Palmetto also administers JJ (Alabama, Georgia, Tennessee) through the same provider portal.
West Virginia's opioid crisis has made urine drug testing one of the highest-risk billing categories in the entire MAC system, with Palmetto JM issuing specific guidance on medical necessity documentation.
Standard quarterly framework for stable diabetic patients; monthly billing needs documentation of a treatment change or new diagnosis.
CMS-855B, submitted to Palmetto GBA Provider Enrollment in Columbia, SC.
