Thursday, June 1, 2023

United Healthcare to Require Z Codes in 8 Weeks

United Healthcare has announced it will require "Z codes" on molecular test claims, and effective August 1, 2023

See the announcement here:

click to enlarge

Like CPT codes, Z-Codes are copyrighted.  Unlike CPT codes, they aren't generally circulated but are submitted as private codes between lab and payer.   Unlike CPT codes, or ICD-10 codes, Z-Codes are submitted via comment fields.  Unlike CPT codes, there is no overall organization to Z codes and there are no "descriptors" but there are paragraph-like test descriptions.    Unlike CPT codes, Z codes are mapped to labs and the lab's own test numbers.

Unlike CPT codes, modifiers are not appended to Z-codes (yet?)


Prior, there were multiple announcements of use of Z codes in United Medicare Advantage (vintage 2021) which would be pre-tested to match Medicare Part B policies, at least those of MolDx.  Here, here, here.

The DEX registry that's publicly available lists 2659 lab entities and 16,222 tests.

See an announcement of the same issue, dated May 2, 2023, at Palmetto, here.