On June 1, United Healthcare (UHC) implemented the Molecular Pathology Reimbursement Policy, which requires DEX Z-codes on genetic test claims to receive payment.
In accordance with Phase 1 of the policy, the following services will now require Z-codes for any tests with dates of service on or after June 1:
- all adult molecular diagnostic tests that are relevant to the Medicare-age population (age 65 years and older);
- Prenatal Carrier Screening tests; and
- specific services billed under 81479, including genetic disease carrier status for procreative management and pharmacogenomics testing including single-gene and multigene panels.
This requirement was initially meant to be implemented in August 2023; however, the College of American Pathologists (CAP) and others successfully advocated for its delay to avoid confusion and complex workflow processes. A deadline was then set for April 1, 2024, to begin enforcing compliance.
On May 31, CAP sent a letter to UHC expressing their continued opposition to this requirement as they “continue to support the use of the CPT code set as the appropriate method to address issues with information on specific tests.” The letter goes on to explain that “the UnitedHealthcare Z-code requirements are needlessly disruptive, burdensome, and financially demanding.”
CAP is not alone in voicing its continued opposition to the Z-code requirements. The American Hospital Association sent a letter in March expressing similar concerns and urging UHC to reconsider the requirements.
UHC encourages those with questions or concerns about the requirements to email them at united_genetics@uhc.com.
Sources:
https://www.dexzcodes.com/palmetto/dex.nsf/DID/5PQ2G7SR9K
https://documents.cap.org/documents/UHC-Z-Code-Letter-5-31-24.pdf
