See a December 18, 2024, update at Palmetto DEX for the latest expansion-of-scope in which United Healthcare commercial plans require Palmetto DEX Z-codes for claim processing.
Find the article here:
https://www.dexzcodes.com/palmetto/dex.nsf/DIDC/XHHX62A8AE
It links to a PDF file of CPT (or PLA) codes that require co-listed Z codes for processing:
Stating in part, 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...
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The PDF document above is divided into 4 tables, each matching to a Phase.
According to the article, Phase I including Medicare-relevant tests, prenatal carrier tests, and two kinds of 81479 tests (PGx and reproductive management carrier screening). Phase 2 included thromboembolism risk tests and high-risk inherited cancer panels. Phase 3 added exome/genome sequencing and "prenatal cell free DNA screening." Finally, now, Phase 4 includes "all remaining molecular pathology relevant CPT codes [Phase 4 code list].
By my count, Phase 1 had 326 codes, Phase 2 had 111 codes, Phase 3 had 30 codes, and Phase 4 had 192 codes, totalling 569 CPT codes, assuming no duplicates amongst the 4 tables.
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For the Palmetto DEX webpage on its commercial payer programs (last updated 11/2023) see:
https://www.dexzcodes.com/palmetto/dex.nsf/DID/DEJUF0KKWB
