Palmetto GBA Test Identifier (PTI) Application Guide

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ContentsCompleting the PTI Application ............................................................................................................. 5Fields Reference.......................................................................................................................................... 6Organization Tab................................................................................................................................ 6Organization Information Fields............................................................................................. 6Contact Information Fields....................................................................................................... 7Medical / Lab Director Information ........................................................................................ 7Credential Information ............................................................................................................. 8Lab Tests Tab....................................................................................................................................... 9General Test Information Fields .............................................................................................. 9Procedure Coding Information Fields .................................................................................. 11Algorithm Field........................................................................................................................ 11FDA Fields................................................................................................................................ 12Instructions Fields ................................................................................................................... 12Additional Test / Assay Information Fields......................................................................... 123
Palmetto GBA Test Identifier (PTI)Application GuideThe Molecular Diagnostic Services (MolDx) program was created to catalog moleculardiagnostic tests to determine coverage and reimbursement policies. May 1, 2012, labswill need to include a Palmetto GBA PTI in the comment / narrative field in its claims.Although Palmetto GBA prefers a Z‐Code identifier, you may obtain and enter anassigned PTI as an alternate test identifier. The PTI uniquely identifies each moleculardiagnostic test and enables a one‐to‐one mapping of a test to the submitted additionalinformation required to obtain the identifier.As the first step in the MolDx program, laboratory providers will register theirdiagnostic tests by completing and submitting an application for a PTI. Onceregistered, each test will be assigned a unique PTI and be added to the Master TestCatalog. The requesting laboratory provider will then be notified of the PTI assignment(allow at least 30 days to receive the assignment).Completing the PTI ApplicationTo complete the PTI Application:1. From www.PalmettoGBA.com, download the following file:PTI Application (PTI_Application.xls)2. Open the PTI_Application.xlsx file in Microsoft Excel.3. Review the information on the Instructions tab.4. In the Organization section, enter your organization’s information. For detailedinformation about each field on this tab, refer to the Organization section fieldreference below.5. Save your changes to the workbook.6. In the Lab section, enter your lab test information. For detailed information abouteach field on this tab, refer to the Lab Tests section field reference below.7. Save your changes to the workbook.8. Repeat steps 7‐8 for each additional lab test you want to add to the workbook byadding the appropriate information to the row below your last entry. For example, the second lab test submitted should be input into row 8.9. Return the completed application via e‐mail to MOLDX@palmettogba.com.5
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