By: Billie Mildenberger, Director of Audit Services
Note: Novitas announced this change will not take effect until Sept. 19, 2024.
Starting Aug. 18th, 2024, Novitas will implement a process impacting newly effective molecular pathology and Proprietary Lab Analysis (PLA) codes. If records supporting the billed codes are not submitted with the initial claim, the service will be rejected.
The claim must then be resubmitted with the appropriate information.
Affected Procedure Codes:
- 0020M
- 0421U
- 0422U
- 0425U
- 0426U
- 0428U
- 0429U
- 0434U
- 0435U
- 0436U
- 0437U
- 0438U
- 0439U
- 0441U
- 0442U
- 0443U
- 0445U
- 0448U
- 0449U
- 0450U
- 0451U
- 0452U
- 0453U
- 0454U
- 0455U
- 0456U
- 0459U
- 0460U
- 0461U
- 0464U
- 0465U
- 0466U
- 0467U
- 0468U
- 0469U
- 0471U
- 0472U
- 0474U
- 0475U
Required Documentation:
To avoid claim rejection, the following documentation must be submitted with the initial claim:
- Orders and test results for the test performed.
- History and physical examination records.
- Progress or office notes related to the test performed.
- Any additional documentation supporting the need for the service.
This policy aims to ensure that all necessary information is provided upfront, streamlining the claims process and reducing delays. Make sure to include all required documents to avoid any disruptions in service claims.
If you need assistance navigating this change, feel free to contact us for a complimentary consultation.
Source: New process for pathology and laboratory codes (novitas-solutions.com)