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June 15, 2020 - Updated 08.25.20

Part A MolDX Claim Submission Instructions

The Molecular Diagnostic Services (MolDX) program requires a unique test ID to be submitted on outpatient hospital claims in addition to the CPT code for the service.

Providers billing for molecular tests performed by a proprietary or reference laboratory must obtain the identifier for the molecular test(s) from the performing laboratory. Part A providers billing for molecular services performed by a hospital-based laboratory must register and obtain a unique test ID for each molecular test in the MolDX code range. To obtain a unique test ID, register with the McKesson Diagnostics ExchangeExternal Website.

NOTE: For MolDX claims submitted on July 20, 2020 and after:

  • Outpatient hospital claims must include the unique test ID in the MolDX test ID field at the detail line level to ensure accurate adjudication of the claim.
  • If an outpatient hospital claim is submitted with a CPT code in the MolDX code range without a valid identifier in the MolDX test ID field, the claim will deny.

Effective April 1, 2019, a MolDX test identification (ID) field was added to the Fiscal Intermediary Shared System (FISS) per CMS MLN Matters article MM10760External PDF.

MolDX Test ID Field Location:

837I Electronic Claim Format Direct Data Entry (DDE)
Element SV202-7 of the 2400 loop MAP171E

DDE Instructions:

  1. From Page 02 (MAP1712) of the claim, press F11 one time to access MAP171E.
  2. Key the MolDX test ID in the MOLDX field for the appropriate claim line (CL) number (i.e., the same claim line that includes the CPT code for the MolDX test on MAP1712).

    Screenshot

EXCEPTION (DDE users only):

  • The MolDX test ID field in DDE will only accept an alphanumeric value of Pxxxx or Zxxxx. Continue to report these identifiers per the instructions above.
  • If you receive an all alpha identifier, do not report it on MAP171E. Instead, report the claim line number, CPT code and MolDX test ID in Remarks (Claim Page 04).

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