UHC Z-Code Requirements for Commercial Test Effective April 1, 2024

United Healthcare’s Molecular Pathology Policy, Professional and Facility was previously announced on May 1, 2023, but delayed in September of 2023 to allow additional time for providers to complete their molecular pathology test registrations for Z-codes on tests.

According to the announcement, the policy will now be effective for dates of service on or after April 1, 2024 and include over 200 CPT codes in the “Wave One” of the registration.

This policy requires the inclusion of a specific Z-Code in the claims process. If laboratories are not already utilizing a Z-Code as mandated by four out of the seven Medicare Administrative Contractors (MACs) or certain Medicare Advantage plans, this announcement may pose challenges and potentially lead to claim denials for clinical laboratories conducting molecular testing. Laboratories not currently registered with the DEX Diagnostic Exchange Registry that plan to submit molecular diagnostic claims are urged to sign up today by visiting the DEX® Registry.

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.

To ensure adequate processing time for both providers and the DEX Registry, Phase 1 will include only a limited number of CPT codes. The services falling within the scope of Phase 1 encompass:

• All adult molecular diagnostic tests that are relevant to the Medicare age population (age 65+)
• Prenatal Carrier Screening tests
• Specific services billed under 81479*
  • Genetic disease carrier status for procreative management
  • Pharmacogenomics testing (PGx) including single gene and multi-gene panel

For more comprehensive information on Z-Codes, you can refer to the XiFin blog titled “Cracking the Code: Mastering Z-Codes for Molecular and Genetic Tests“.