Palmetto GBA Test Identifier (PTI) Application Guide

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Palmetto GBA Test Identifier (PTI) Application GuideField NameTest TypeTest Type DescriptionBranch of MedicinePrimaryBranch of MedicineSecondaryMethodology PrimaryMethodology PrimaryDescriptionMethodology SecondaryMethodology SecondaryDescriptionAliasesDescription Column entry is required. Select Test Type associated with the test/assay from thedropdown options. If none of the options qualify, choose "Other" and describe testtype in next column. This information will be exposed for public view. Column entry is required ONLY if previous column = "Other." If the previous column was answered "Other", provideinformation to categorize the test/assay. Acceptable format: free-text entry. This information will be exposed for public view. Column entry is required. Select the Branch of Medicine primarily associated with thetest/assay from the dropdown options. This information will be exposed for public view. Column is optional. If applicable select the Branch of Medicine secondarilyassociated with the test/assay from the dropdown options. This information will be exposed for public view. Column entry is required. Select the Methodology primarily associated with the test/assayfrom the dropdown options. If none of the options qualify, choose "Unlisted" and describemethodology in next column. This information will be exposed for public view. Column entry is required ONLY if previous column = "Unlisted." If the previous column was answered "Unlisted," provideinformation to best describe the methodology of the test/assay Acceptable format: free-text entry. This information will be exposed for public view. Column entry is required. Select the Methodology primarily associated with the test/assayfrom the dropdown options. If none of the options qualify, choose "Unlisted" and describemethodology in next column. This information will be exposed for public view. Column entry is required ONLY if previous column = "Unlisted." If the previous column was answered "Unlisted," provideinformation to best describe the methodology of the test/assay. Acceptable format: free-text entry. This information will be exposed for public view. Column is optional. Provide any different descriptions, abbreviations, or keywordsused by the general public that apply to the test/assay. Acceptable format: free-text entry. If more than one alias exists,comma-delimit the entries (i.e. separated by commas). This information will be exposed for public view.10
Fields ReferenceField NameDescriptionContributing Components Column entry is required. Do not include intellectual property. List all of the components / analytes / formulas / calculations /biomarkers, etc. that make up the test/assay. Formulas, calculations, biomarkers, etc. need only be identifiedas such. Do not include intellectual property. Acceptable format: free-text entry. If more than one componentexists, comma-delimit the entries (i.e. separated by commas). Confidential: This information will not be exposed to public view.Procedure Coding Information FieldsField NameCPT Code(s)HCPCS CodeDescription Column entry is required. Provide the CPT code(s) used to bill or place the test/assay ona claim. If units of a particular CPT code are performed or billed morethan one time, provide the appropriate units in parentheses tothe right of the CPT code. Acceptable format: numeric. If more than one CPT code isentered, comma-delimit the entries (i.e. separated by commas). Confidential: This information will not be exposed to public view. Column is optional. Provide the HCPCS code used to bill or place the test/assay ona commercial payer claim. If the CPT code column is defined, this column need not bedefined. Acceptable format: alphanumeric. Confidential: This information will not be exposed for publicview.2012 CPT code Column entry is optional but strongly recommended if a 2012CPT tier 1 code exists. If the test/assay is affiliated with a new molecular/genetic CPTcode provided by the AMA in 2012, enter the tier 1 CPT code. Acceptable format: numeric. Confidential: This information will not be exposed to public view.Algorithm FieldField NameAlgorithmDescription Column entry is required. Indicate, via the dropdown options, if the test/assay uses analgorithm. Acceptable format: Y/N. Confidential: This information will not be exposed to public view.11
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