UHC Expanding Z-Code Requirements to Commercial Plans

On August 1^st, UnitedHealthcare commercial plans will require providers to include a Z-Code when submitting molecular diagnostic test claims for reimbursements. For laboratories that are not already using a Z-Code as required by 4 of the 7 MACs or certain Medicare Advantage plans, this announcement may present a challenge and result in denials for many clinical laboratories performing molecular testing. According to the announcement, nearly 250 CPT codes are included in the “Wave One” of the registration.

Laboratories will need to adapt their billing practices to comply with this new requirement to avoid claim denials and should continue to monitor how this announcement will impact payor policies for other commercial health plans.

In the recent Dark Report article Clarisa Blattner, Senior Director of MDx Support at XiFin, commented “It’s likely that if your lab already has a Z-code for the MolDX program, you may be able to repurpose that same Z-code for the UnitedHealthcare program as well. However, for those molecular lab companies that are not participating in the MolDX program, the UHC announcement is going be something new for them,” she added.

Check out the article “UHC’s Z-Code Requirement to Commence on August 1” by XiFin’s Clarisa Blattner from The Dark Report 5/30/23 for more information on the Z-Code and United Healthcare’s new policy.

Source: https://www.dexzcodes.com/palmetto/dex.nsf/DID/5PQ2G7SR9K