UnitedHealthcare announced its policy requiring DEX Z-Codes for molecular diagnostic testing will be effective for dates of service on or after April 1, 2024.
“The policy will require the submission of a DEX Z-Code obtained from the DEX Diagnostics Exchange Registry for claims to be considered for reimbursement,” according to a Jan. 4 press release from Palmetto GBA. Claims will be denied if any DEX Z-code information is missing or invalid and may be resubmitted with the required information.
Other commercial payers may also begin requiring the use of Z-codes, according to Palmetto GBA, which recommends providing the Z-Code on a claim with the appropriate CPT code to clearly identify the test being performed and eliminate administrative burden. This policy will apply to facility and professional claims.
The following services will require Z-codes in phase 1:
- All adult molecular diagnostic tests that are relevant to the Medicare age population (age 65 years and older)
- Prenatal Carrier Screening tests
- Specific services billed under 81479, including genetic disease carrier status for procreative management and pharmacogenomics testing including single-gene and multigene panels
Palmetto GBA suggests submitting the test(s) before the deadline to allow time to identify and fix possible errors or omissions with test submissions. All laboratories planning to submit molecular diagnostic testing claims must be registered with the DEX Diagnostic Exchange Registry.