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Industry Insights

MolDX removes coverage for BioFire, GenMark respiratory panels

As of Oct. 1, MOLDX has updated their LCDs/Billing and Coding Articles for the Multiplex Nucleic Amplified Tests for Respiratory Panels to no longer cover the PLA codes 0098-0099U, U100U, and 0115U. These PLA codes represent respiratory panels using BioFire® or GenMark® platforms.

The only code deemed medically necessary is 87631 – Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets.

Additionally, the panel now may be ordered by independent labs (POS 81). Previously the panel was only billable for POS 20, 21 or 23 unless ordered by an infectious disease specialist who was diagnosing and treating the patient.

MOLDX is active in the following MACS:

  • Palmetto
  • Noridian
  • CGS
  • WPS

RCM Solutions is currently doing a deeper dive into this issue; however, it is important to notify those in the impacted MACS that are looking to perform respiratory panels greater than five targets.

Interested in learning more about navigating MolDX, Technical Assessments or improving your overall revenue cycle management? Contact us today for a free consultation.


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