UnitedHealthcare (UHC) will enforce compliance with new DEX Z-code requirements for molecular diagnostic testing on April 1.

The DEX Z-code submission process for claims will take place in phases, with codes for the services listed below needing to be registered in the DEX Diagnostic Exchange Registry by April 1 to avoid any payment disruptions. These codes will be required for any tests with dates of service on or after April 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.

UHC will provide updates on future phase timing. The phases are planned for later in 2024, but specific dates have not been announced.

Initial review for Z-code assignment will take place within two weeks of the test registration. Within 60 days of the Z-code assignment, UHC will notify laboratories of their assigned CPT code to be used on claims with the Z-code. For claims submitted with errors, UHC will send a Smart Edits message within 24 hours with instructions on how to correct the error.

The College of American Pathologists met with UHC representatives to express its continued opposition with the policy, saying it would “result in complex workflow processes that will be difficult for CAP members, especially those unfamiliar with Palmetto.” During their meeting, UHC explained that the following resources would be available to help with the transition:

  • “Provider advocates” who are engaged and monitoring labs and who will reach out to help with the Z-code process.
  • Increased communication with Palmetto and within hospital systems.
  • A commitment to work collaboratively with providers to understand who is struggling with the new process.

Additionally, UHC encourages those with questions or concerns about the requirements to email them at united_genetics@uhc.com.