Molecular Testing Reimbursement

To reduce denials and protect molecular testing revenue it is imperative for laboratories to be aware of payer policy changes. As such some payers have established their own molecular policies while other payers follow the Palmetto LCD A58710 – this LCD is quite restrictive. Humana and UHC have been identified as following the Palmetto LCD. Due to the complexity in their requirements and the limited coverage, TELCOR recommends thoroughly reading the Palmetto article for information about billing and any additional information provided within the Group the CPT falls under. These sections often contain nuances that determine whether a claim is payable.

Overall, we believe laboratories that monitor payer policy adoption, understand LCD-specific nuances, and evaluate billing strategies proactively are best positioned to handle the challenges associated with molecular testing reimbursement.

- Kwami Edwards, Chief Operations Officer, RCM