UnitedHealthcare® Commercial Plan Phase 3 Test Registrations for Molecular Diagnostic Testing

Published 10/01/2024

UnitedHealthcare has announced Phase 3 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 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.
  • The Z-Code can be submitted on claims once you have received email notification that the test has been assigned a recommended CPT® code and the assessment is complete. This typically occurs within 60 days from Z-Code assignment.
  • Additional documentation may be required dependent on test complexity. In which case you will be notified by email.
  • For further guidance on the timeline for the registration of your tests, refer to DEX Diagnostics Exchange Test Registration.

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.