United Healthcare Start Date for Z-Code Requirements Now April 1st

February 13, 2024

United Healthcare (UHC) has announced that its Z-code requirement for certain genetic tests on commercial plan claim submission will now become effective April 1, 2024.

UHC first announced its Z-code requirement for commercial plan claims back in the spring of 2023, with the initial effective date of August 1, 2023.  The new effective date of April 1, 2024 is not expected to be delayed again. UHC currently covers 27.3 million commercial health plan members in the United States.

UHC has already been requiring the use of Z-codes on their Medicare Advantage plans for nearly two years. Along with UHC Medicare, Traditional Medicare MACs Palmetto GBA, Noridian, WPS and CGS also already require the use of Z-codes on Part B claims. Labs servicing these MAC jurisdictions should be well prepared for the new UHC Z-code requirement for commercial members. The three non-participating MACs are National Government Services, Novitas and First Coast.

Labs located in the three MAC regions not participating in MolDX will need to get Z-codes in order to receive reimbursement for Molecular tests they perform on UHC Commercial members.

Z-Codes are a five-character alphanumeric code assigned to molecular diagnostic tests by Palmetto GBA’s MolDX program. Z-codes are used in conjunction with the CPT® codes on lab claims.

Each Lab must register their organization with the DEX Diagnostics Exchange.  Next, the Lab must register each unique test in the DEX System, and the DEX team will review the test application and will assign the Z-code and CPT to the test. This process takes approximately 2 weeks. For more information on this process, refer to the MolDX website.

If your lab sends an applicable test to a reference lab to be performed and intends to bill UHC, you will need to request the performing lab to share the Z-code assigned to the performing lab and include it on the claim. Labs only need to register for Z-codes for tests that are performed in house.

UHC’s new policy requirement will initially cover 133 CPT Codes, as well as 104 proprietary lab analysis (PLA) codes.  UHC is likely to add the requirement to certain PCR-based microbiology test claims for commercial plans within the next 12 months as well.

After April 1st, commercial claims for these tests will be denied if the Z-code is missing, invalid or does not match the service represented by the CPT code reported on the claim, according to a UHC policy bulletin issued in early January.

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