UnitedHealthcare® Commercial Plan Phase 4 Test Registrations for Molecular Diagnostic Testing

UnitedHealthcare has announced Phase 4 of the DEX® Z-Code requirement for certain molecular diagnostic test services on facility and professional claims. This is part of the UnitedHealthcare Molecular Pathology Policy, Professional and Facility. Please visit UHC’s Network News for more.

The policy will require the submission of a Z-Code obtained from the DEX® Diagnostics Exchange Registry for claims to be considered for reimbursement. Claims for molecular pathology services will be denied if the Z-Code information is missing, invalid, or does not match the service represented by the CPT® code reported on the claim. Claims denied for missing or invalid information may be resubmitted with the required information.

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. To allow sufficient processing time for both providers and DEX Registry processing, a limited number of CPT codes will be part of a phased rollout. Please review the list of CPT codes in each phase listed below.  If you bill with one of the CPT codes on the corresponding list, or perform services as described below, you will need to register in the DEX Registry for Z-Code assignment at this time.

View a list of CPT codes (PDF)

Phase 4 Scope includes: 

• All remaining Molecular Pathology relevant CPT codes required for Z-Code submission as defined in the Phase 4 CPT code list
  • NOTE: Technical Assessment requirements may vary. See below for information on what to expect.

Phase 3 Scope includes: 

• Exome and Genome sequencing
• Prenatal cell-free DNA Screening
• Molecular Pathology Tier 2 Codes

Phase 2 Scope includes: 

• Venous Thromboembolism Risk and Hereditary Thrombophilia Testing
• Diagnosis and High-Risk Inherited Cancer Panel
• New CPT and PLA codes relevant to scope of services announced

Phase 1 Scope includes: 

• 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

Why submit your test(s):

Submitting your tests as soon as possible will:

• Allow time to identify and fix possible errors or omissions with your test submission.

What to expect after you complete your registration:

• The initial review for Z-Code assignment takes approximately 2 weeks from test submission.
• Additional Technical Assessment (TA) documentation may be required dependent on test complexity and TA evaluation procedure established. If your test is identified as requiring additional TA documents, you will receive an email from DEX. For more information, refer to DEX - 4. Technical Assessment (TA) Evaluation
• The Z-Code can be submitted on claims once you have received email notification that the test has been assigned a recommended CPT code
  • For tests that do not require additional TA documentation, or we have not received the required documentation, this is complete in approximately 3 - 4 weeks.
  • For tests that have submitted additional TA documentation, this process can take up to 60 days.
• Some services may not have a TA evaluation procedure in place yet. These tests will be updated with a recommended CPT code and a Non-Medicare TA Result of N/A and can submitted on claims with the appropriate Z-Code and CPT code. If the test type is determined to be part of a future TA evaluation requirement, you may be notified at that time if and when additional documentation is required.

Have more questions?

• If you have any questions or are not sure if your test requires submission now or in the future, please visit the DEX Website for more information or contact customer service at DEX.Customer.Service@PalmettoGBA.com.
• Upcoming communications will alert you to additional CPT code lists and timing.
• For questions specific to UnitedHealthcare Policy please contact United_Genetics@UHC.com.