Is there an exception to the Date of service (DOS) policy?
Yes, in the case of a molecular pathology test, or an Advanced Diagnostic Laboratory Test (ADLT) that meets the criteria of section 1834A(d)(5)(A) of the Social Security Act, the date of service must be the date the test was performed, only if the following conditions are met:
– The test is performed following a hospital outpatient’s discharge from the hospital outpatient department:
– The specimen was collected from a hospital outpatient during an encounter (as both are defined 42 CFR 410.2);
– It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter;
– The results of the test do not guide treatment provided during the hospital outpatient encounter; and
– The test was reasonable and medically necessary for the treatment of an illness
Below is an outline of the scenarios under which the Medicare date of service rules will apply to Agendia’s tests. The decision to submit an order for testing should be guided by the clinical judgment of the ordering physician and should not be based on the application of any billing rules.