First Wave Special Notice to Medicare Advantage Providers

Published 12/30/2021

Z-Codes ™ will be used by Medicare Advantage Payors 

On October 1, 2021, certain national Medicare Advantage Payors began requiring providers to submit DEX Z-Codes™ for molecular diagnostic test services. Other Medicare Advantage payors may similarly start utilizing and requiring the use of DEX Z-Codes ™. If you have been notified by your Medicare Advantage Payor that this applies to your billed services, you are subject to this notice and are urged to comply with the instructions below. 

To avoid potential loss of coverage or reimbursement for molecular diagnostic tests, we advise you to register your organization on the DEX™ Diagnostics Exchange registry as soon as possible. Please review the requirements below for submitting your molecular diagnostic test services for Z-Code ™ assignment and technical assessment.   

Evaluation and enforcement of Z-Codes ™ will be conducted on a rolling basis in phases.  If you already have a Z-Code ™ for your test, you are required to use that code on the claim as instructed by your payor.  If you do not yet have a Z-Code ™ for your test, then you must determine if your test requires submission to the DEX Registry at this time based on the current phase of the rollout.  The deadline for test submission for the first rollout phase is March 1st, 2022

Determining if your test requires submission to the DEX Registry for March 1, 2022 deadline: 

If you have not yet received a DEX Z-Code ™ for your molecular diagnostic test and are currently providing that service and billing one of the below CPT codes, your service is due for immediate submission to the DEX Registry for Z-Code assignment. 

Wave I CPT Codes
81206 81241 81342
81207 81256 81355
81210 81261 81404
81225 81264 81408
81226 81286 81439
81235 81291 81445
81240 81340  

The current due date for submission for all tests that are defined by or bill with the above CPT codes is March 1st, 2022.  If submissions are not made by this date, you may experience a lapse of coverage or reimbursement for your service. 

Why submit your test (s) before the March 1, 2022 deadline:  

Reimbursement will only be made for services that demonstrate compliance with existing Medicare policies via a successful technical assessment once the deadline is past. Incomplete submissions or services that otherwise do not demonstrate they meet coverage criteria as defined by relevant Medicare policy will not be reimbursed. 

However, enforcement of Z-Codes ™ and test assessments will not occur until after the deadline.  As a result, submitting your tests as soon as possible: 

  • Allows time to identify and fix possible errors or omissions with your test submission.
  • Allows you to possibly identify and remedy test limitations that would preclude coverage under existing policy without loss of reimbursement until the deadline.
  • Note: It takes approximately 2 weeks from test registration to receive a Z-Code, however, a technical assessment is required to determine if services meet coverage criteria. 
    • For tests that do not require additional documentation, this is complete in approximately 3-4 weeks.
    • For more complex testing requiring technical assessment documentation review, the process will take additional time.