In another move toward evidence-based genetic test management, both Humana and UnitedHealthcare (UHC) this month updated their Z-Code requirements for molecular diagnostic test (MDx) claims.
Effective September 18, Humana Medicare Advantage (MA) plans began requiring providers to submit the Z-Codes. Select national MA payers have begun participating in Medicare Administrative Contractor Palmetto GBA's Diagnostic Exchange (DEX), Palmetto announced. Among the tests in focus are certain RNA- and DNA-based tests, and certain MA Current Procedural Terminology (CPT) codes.
Using a DEX Z-Code on a claim, with the appropriate CPT code, will clearly identify the test being performed, according to UnitedHealthcare (UHC), which just initiated the second phase of its new molecular pathology policy for its commercial plans. The Z-Codes will also eliminate some of the administrative burden typically encountered with billing for these tests using CPT codes, UHC said.
According to UHC, providers must report molecular pathology and molecular diagnostic tests (MDT) with the CPT and/or Healthcare Common Procedure Coding System (HCPCS) code(s) that most accurately describes the specific test performed, as assigned through the Palmetto DEX Z-Code registry. UHC's phase 2 Z-code requirements apply to claims beginning with dates of service on or after November 1, 2024.
Z-Codes have emerged as a standard used by health plans. Clinical laboratories that do not have a Z-Code for their test must determine if the test requires submission to the DEX Registry now based on the current list of CPT codes, according to Palmetto. Read a special notice from Palmetto here.
