MPLN adheres to the guidelines set forth by CMS and Commercial insurance plans. Please see our Notice of Compliance below for additional information regarding payer requirements and client billing of testing.
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Medicare Administrative Contractor (MAC) change effective February 26, 2018.
Palmetto, GBA has been awarded the MAC contract for Tennessee, Alabama and Georgia. Palmetto, GBA has additional requirements that our current MAC does not have. Once such requirement is Palmetto, GBA established a Molecular Diagnostics (MolDx) program that requires Medicare claims have Z-codes for molecular tests prior to claims submission.
|Code Category/Description||2018 MolDX CPT Code Range|
|Genomic Sequencing Procedures||81410-81471|
|Molecular Multianalyte Assays (MAAA)||81490-81595|
|MAAA Admin Codes||All Codes|
|Microbiology||87505-87507, 87631-87633, 87149-87150|
|Not otherwise classified (NOC)||81479, 81599, 84999, 85999, 86849, 87999, 88199, 88299, 88399, 89398|
In order to have access to the Z-codes for our tests each hospital or laboratory organization will need to register in the DEX Diagnostics Exchange. The website to register in the Diagnostics Exchange is https://app.dexzcodes.com To co.mplete registration you will need your NPI and CLIA #s. The instructions for submitting a sharing request are outlined below:
How to make a sharing request
Medical necessity guidelines are provided by Centers for Medicare & Medicaid (CMS). MPLN encourages clients to utilize an Advanced Beneficiary Notice (ABN) on any laboratory procedure that Medicare may not deem as medically necessary. Without a signed ABN on file, MPLN reserves the right to bill the client for any tests deemed not medically necessary.
MPLN bills Medicare through Palmetto GBA in Tennessee and Virginia. MPLN accept Medicare's allowed rates as 100% of payment. If Medicare pays only a co-insurance amount of the allowed Medicare rate, or if the patient's deductible is not met, then the patient is responsible for the difference. MPLN accepts the Medicaid allowed rate as full payment. We are enrolled in the following state Medicaid programs: Alabama, Florida, Georgia, Kentucky, North Carolina, Maryland, South Carolina, Tennessee, Virginia, and West Virginia.
At MPLN, we work with each client to set up the best method of payment for them and their patients. The forms of payment we accept are listed below. In addition, patients have the option to pay their laboratory bill online.
For MPLN to bill an insurance company or third party administrator, be sure to include the following information on the requisition form:
Patients are responsible for co-payments, deductibles and/or outstanding balances not covered by insurance. If your patient has a question about their laboratory bill, he or she is welcome to call MPLN directly.
MPLN is a member of insurance networks across the country. Below you will find the current list of our participating insurance providers. TN and VA participating and non-participating Insurance providers (Nov 2018)
We can bill patients directly if the test requisition form is complete and includes the responsible party's name, address and telephone number.
Our facility fee schedule may be discounted based on a client’s total test volume with MPLN and its subsidiaries. Clients are billed on a monthly basis by an itemized invoice and terms are payable upon receipt. Any adjustments are shown on the following month’s statement. Clients who have collections past due 90 days are sent a written notification. If you have any questions, please call the client billing department at 800.932.2943
The Current Procedural Terminology (CPT) Codes that MPLN provides in its reports and other literature are based on our interpretation of CPT code requirements and are subject to review and change. It is our clients' responsibility to verify the accuracy of the codes listed and assign value based on reimbursement for your area. If you have questions about usage of CPT codes, contact your Medicare carrier.