1. Program Overview

DEX is a web-based application designed to identify tests and help establish transparency between providers and payers. This tool enables labs to confidentially share test information with participating payers online. Labs register as an entity on the platform and submit their tests for review. Please visit the DEX Diagnostics Exchange Registry to login and use the platform

The Z-Code is a unique identifier that clearly identifies the test being performed on a claim, allowing the payer to know exactly what service was rendered. Providing the Z-Code on a claim, with the appropriate Recommended CPT® Code, may reduce the administrative burden labs may encounter surrounding billing for these services as it provides a means for the payer to automate adjudication or pre-authorization of claims. The Z-Code allows the payer to reproducibly and reliably assess medical necessity based on registered test information (such as intended use, methodology, and performance).

• Medicare contractors participating in the MolDX® program:
  • JM A/B (N.C., S.C., Va., W.Va.) and JJ A/B (Tenn., Ga., Ala.) administered by Palmetto GBA
  • JE A/B (American Samoa, Calif., Guam, Hawaii, Nev., North Marina Islands) and JF A/B (Ark., Ariz., Idaho, Mont., N.D., Ore., S.D., Utah, Wash., Wyo.) administered by Noridian Healthcare Solutions.
  • J5 A/B (Iowa, Mo., Kan., Neb.) and J8 A/B (Mich., Ind.) administered by WPS Government Health Administrators.
  • J15 A/B (Ky., Ohio) administered by CGS Administrators, LLC.
  • For more information and directions pertaining to the MolDX program, please visit their website at www.PalmettoGBA.com/MolDX
• Participating payers will direct you to register in DEX and obtain Z-Codes if and when required. Current participating programs:
  • UnitedHealthcare® (Medicare Advantage and Commercial)
• Other payers participating with DEX (requirements may vary):
  • Medical Mutual of Ohio
  • Fallon Health
  • Blue Cross® and Blue Shield® of North Carolina

Note: Please review applicable payer policies for specific CPT® codes.

See Test Submission Requirements for more information about FDA-approved/cleared tests.

*NOTE: At this time, molecular syndromic panels for infectious disease pathogen identification that have a CPT® code in this range and are FDA-approved/cleared do not require the performing laboratory to add the test to the DEX Registry for a Z-Code unless specific criteria are met.