UnitedHealthcare (UHC) is making changes to how it will process claims for molecular diagnostic tests (MDT).
Effective Aug. 1, UHC commercial plans will require providers to submit DEX Z-codes along with the CPT code for any test that involves multiple genes that produce a single result, in accordance with a UHC reimbursement policy update. According to Palmetto GBA, which administers the DEX Diagnostic Exchange, providing the Z-code with the appropriate CPT code will help to identify the test being performed and alleviate some of the administrative burden associated with billing for these services.
Each laboratory must register with the DEX Diagnostics Exchange Registry. Wave I of the reimbursement policy update includes about 250 CPT codes. After this wave, UHC will issue several additional waves until all codes within scope are completed. Once registered, laboratories that bill with one of the CPT codes on the corresponding list will need to register each unique test in the DEX Registry for Z-code assignment.
For custom panels, laboratories are required to register all components of a panel, whether in scope or out of scope of the program. DEX will only map tests that are in scope for the program, including: all adult molecular diagnostic tests that are relevant to the Medicare age population; prenatal cell-free DNA screening and carrier screening tests; genetic disease carrier status for procreative management; and pharmacogenomics testing including single gene and multi-gene panels. A complete list of diagnostic services that fall within the scope of DEX can be found on the Centers for Medicare & Medicaid Services website.
Because Z-code enforcement begins Aug. 1, laboratories are encouraged to register and submit their tests as soon as possible. The initial review for Z-code assignment takes about two weeks from submission.
Sources:
https://www.dexzcodes.com/palmetto/dex.nsf/DID/5PQ2G7SR9K
