What are the criteria for the DOS exception mentioned in last week’s question?


According to the Centers for Medicare & Medicaid Services (CMS), the date of service (DOS) of the molecular pathology or CMS designated ADLT test must be the date the test was performed under the following criteria according to paragraph (1) of the definition of an ADLT in § 414.502.

  • “The test was performed following a hospital out- patient’s discharge from the hospital outpatient department
  • The specimen was collected from a hospital outpatient during an encounter (as both are defined in 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.”

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