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{"DID":"crit2eb32b","Sites":"DEX","Start Date":"06-01-2022 00:47","End Date":"06-30-2022 19:00","Content":"Attention: Please take a look at the Top News update for important information for Medicare Advantage Payors fourth wave.","URL":"https://www.dexzcodes.com/palmetto/dex.nsf/DID/07860YUDBI","Target":"_self","Color":"blue","Mode":"Standard\n","Priority":null}, {"DID":"crit3125a4","Sites":"DEX","Start Date":"08-29-2025 08:00","End Date":"09-01-2025 23:00","Content":"DEX Customer Service will be closed on September 1, 2025, in observance of Labor Day.","URL":"","Target":null,"Color":"green","Mode":"Standard\n","Priority":"no"}, {"DID":"crit3ac124","Sites":"DEX","Start Date":"11-24-2025 08:00","End Date":"11-28-2025 23:00","Content":"DEX Customer Service will be closed on November 27 and 28, 2025, in observance of the Thanksgiving holiday.","URL":"","Target":null,"Color":"green","Mode":"Standard\n","Priority":"no"}, {"DID":"crit4d4e3e","Sites":"DEX","Start Date":"07-02-2025 00:00","End Date":"07-04-2025 21:00","Content":"DEX Customer Service will be closed on July 4, 2025, in observance of Independence Day.","URL":"","Target":null,"Color":"green","Mode":"Standard\n","Priority":"no"}, {"DID":"crit5d3bcc","Sites":"DEX","Start Date":"01-16-2025 14:53","End Date":"01-20-2025 17:30","Content":"DEX Customer Service will be closed on January 20, 2025, in observance of Martin Luther King Jr. Day.","URL":"","Target":null,"Color":"green","Mode":"Standard\n","Priority":"no"}, {"DID":"crita5be51","Sites":"DEX","Start Date":"05-23-2025 07:00","End Date":"05-26-2025 18:00","Content":"DEX Customer Service will be closed on May 26, 2025, in observance of Memorial Day.","URL":"","Target":null,"Color":"green","Mode":"Standard\n","Priority":"no"}, {"DID":"critbc15cb","Sites":"DEX","Start Date":"05-24-2024 08:00","End Date":"05-27-2024 18:00","Content":"DEX Customer Service will be closed on May 27, 2024, in observance of Memorial Day.","URL":"","Target":null,"Color":"blue","Mode":"Standard\n","Priority":"no"}, {"DID":"critc242ce","Sites":"DEX","Start Date":"05-23-2025 08:00","End Date":"05-26-2025 17:30","Content":"DEX Customer Service will be closed on May 26, 2025, in observance of Memorial Day.","URL":"","Target":null,"Color":"green","Mode":"Standard\n","Priority":"no"}, {"DID":"critcc2b25","Sites":"DEX","Start Date":"12-19-2025 08:00","End Date":"12-25-2025 23:00","Content":"DEX Customer Service will be closed on December 24 and 25, 2025, in observance of the Christmas holiday.","URL":"","Target":"_self","Color":"green","Mode":"Standard\n","Priority":"no"}, {"DID":"crite2be25","Sites":"DEX","Start Date":"08-23-2022 09:53","End Date":"08-29-2022 09:00","Content":"Palmetto GBA will be performing a system upgrade on the DEX (TM) Registry Thursday, August 25th at 5pm ET through Monday, August 29th at approximately 8am ET. For any questions, please contact DEX.customer.service@palmettogba.com","URL":"","Target":"_self","Color":"yellow","Mode":"Standard\n","Priority":"yes"}

Technical Assessment Forms

Published 04/07/2025

Download Technical Assessment Forms (PDF)

TA Form	Required Test
GEN-CQD-003 Technical Assessment Submission Checklist	All tests submitting a Technical Assessment *UPDATED 4/7/2025*
GEN-PF-001 Technical Assessment (TA) Summary Form	Tests with results that are either novel or proprietary technology and/or algorithms. Tests that require an evaluation of clinical utility or clinical validity that is not already established in existing policies or standards of care.
SOM-PF-004 Analytical and Clinical Validation Summary Worksheet, Solid Tumors Formerly NGS-PF-004: Analytical Validity, Clinical Validation Summary Worksheet, NGS Solid Tumors	“Targeted” Panel – Solid Tumor and Solid Tumor, plasma-based “Comprehensive Genomic Profile” – Solid Tumor and Solid Tumor, plasma-based *UPDATED 4/7/2025*
SOM-PF-005 Analytical and Clinical Validation Summary Worksheet, Myeloid Malignancies Formerly NGS-PF-005: Analytical Validity, Clinical Validation Summary Worksheet, Myeloid Malignancies	“Targeted" Panel – Hematopoietic Malignancy “Comprehensive Genomic Profile” – Hematopoietic Malignancy *UPDATED 4/7/2025*
GER-PF-006 Analytical Validity, Clinical Validation Summary Worksheet, Inherited Cancer Testing	Inherited Cancer Testing
NGS-PF-002 Analytical Validity – Performance Specifications for Comprehensive Genomic Profiling Checklist, Somatic	NGS “Comprehensive Genomic Profile” – Solid Tumor and Solid Tumor, plasma-based NGS “Comprehensive Genomic Profile” – Hematopoietic Malignancy RETIRED 4/7/2025
MRD-PF-016 Analytical Validity, Clinical Validity Summary Worksheet, MRD	Minimal Residual Disease (MRD) Testing
MRS-PF-020 Analytical Validity, Clinical Validity Summary Worksheet, MRS	Molecular Testing for Risk Stratification (MRS) Example: Biomarkers
MID-PF-019 Analytical Validity, Clinical Validation Summary Worksheet, Syndromic Infectious Disease Panels	Molecular Testing for Syndromic Infectious Disease (MID)
GER-PF-008 Analytical, Clinical Validation Summary Worksheet, Inherited Germline Testing	Inherited Germline Testing for Non-Cancer
GER-PF-023 Analytical Validity, Clinical Validation Summary Worksheet, Venous Thromboembolism Risk and Hereditary Thrombophilia	Venous Thromboembolism Risk and Hereditary Thrombophilia
GER-PF-024 Analytical Validity, Clinical Validation Summary Worksheet, Whole Exome or Whole Genome	Whole Exome Sequencing (WES) Whole Genome Sequencing (WGS)
PCFS-PF-021 Analytical Validity, Clinical Validation Summary Worksheet, PCFS	Prenatal cell-free DNA Screening (PCFS)
PCS-PF-022 Analytical Validity, Clinical Validation Summary Worksheet, PCS	Prenatal Carrier Screening (PCS)
PGX-PF-007 Pharmacogenomics Submission Form	Pharmacogenomics (PGx) tests
ALLO-CQ-003 Technical Assessment Submission Checklist and Questionnaire for Solid Organ Allograft Rejection	Molecular Testing for Solid Organ Allograft Rejection
ALLO-PF-009 Allograft Rejection Performance	Molecular Testing for Solid Organ Allograft Rejection
GEN-PF-010 Gapfill Worksheet	Required for tests that must be priced by Palmetto GBA