UnitedHealthcare to Require DEX Z-Codes for Molecular Diagnostic Tests in Phase 3
Key Insights
UnitedHealthcare (search) will require DEX Z-Codes for certain molecular diagnostic tests under phase 3 of the DEX Z-Codes program, effective for dates of service on or after January 1, 2025.
This requirement applies to both facility and professional claims for UnitedHealthcare (search) commercial plans, as part of the updated Molecular Pathology Reimbursement Policy.
Laboratories are urged to register with Palmetto's DEX Diagnostics Exchange to obtain the necessary Z-Codes for their tests to ensure reimbursement.
Beginning October 1, healthcare providers can register tests in scope for phase 3 of the DEX Z-Codes for specific molecular diagnostic test services on facility and professional claims. This initiative is part of UnitedHealthcare (search)'s recently updated Molecular Pathology Reimbursement Policy, which took effect June 1, 2024, for UnitedHealthcare commercial plans.
Claims for eligible phase 3 tests with dates of service on or after January 1, 2025, must include the appropriate Z-Codes to be considered for reimbursement. UnitedHealthcare (search) previously announced the requirement for Z-Codes on certain molecular diagnostic testing facility and professional claims for claims to be considered for reimbursement.
Healthcare providers can review the test codes included in phases 1–3 to ensure those are already registered. Laboratories that have not registered with Palmetto’s DEX Diagnostics Exchange should begin their registration today by visiting dexzcodes.com.
The use of the DEX Z-Code on a claim, along with the appropriate CPT code, will clearly identify the test being performed and alleviate some of the administrative burden surrounding billing for these tests with CPT codes. This requirement applies to both facility and professional claims.
For further guidance on the timeline for the registration of tests, healthcare providers can view the DEX Diagnostics Exchange test registration page.