LCD from Novitas and multiple MAC's
We have facilities in Pennsylvania with Novitas Solutions, Inc as the MAC. I am particularly interested in the Article- Billing and coding: Respiratory Pathogen Panel Testing (A58575). The Article Guidance Article Text This - Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38916, Respiratory Pathogen Panel Testing.
Please refer to the LCD for reasonable and necessary requirements. Coding Guidance Created on 05/09/2025. -Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.
Please note: The services addressed in this article and related LCD are not applicable to providers submitting claims on institutional claim forms.
I wanted to confirm your interpretation of the statement on - Please Note is referring to all claims that are submitted on a UB from the hospital, and the LCD would not apply, and NO modifier should be appended if there was no diagnosis to support.