Select Page

Industry Insights

Medicare Advantage Payors to Require DEX Z-Codes

By: Cassie Penn, Client Manager

On October 1, 2021, certain Medicare Advantage Payors, such as UHC, began requiring providers to submit DEX Z-Codes. Other Medicare Advantage Payors may now similarly start utilizing and requiring the use of DEX Z-Codes, according to a recent announcement from MolDX.

Currently, there is not a list of Medicare Advantage Payors participating. If you have been notified by your Medicare Advantage Payor that this applies to your billed services, you are subject to the notice and urged to apply for a Z-Code. This can apply to labs that do not reside in a MolDX MAC, such as Novitas.

If you have received notification from your Medicare Advantage Payor, it is important to register for a DEX Z-Codes to avoid potential loss of coverage. If your test already has a Z-Code, you are required to use that Z-Code. If you do not have a Z-Code, then you must determine if your test requires a Z-Code. Test can be registered via the MolDX Program.

The DEX Exchange is utilizing waves of required CPT codes to determine test registration. Currently, the registration dates are in the third wave.

  1. Spring Registration – Third Wave
    • Due June 15, 2022
  2. Summer Registration – Fourth and Fifth Wave
    • Fourth Wave due July 1, 2022
    • Fifth Wave due August 1, 2022
  3. Fall Registration – Sixth and Final Wave
    • Sixth Wave due September 1, 2022
    • Final Wave due November 1, 2022
Link to see all the CPT codes for each wave DEX CPT Code Waves.pdf (dexzcodes.com)

If submissions are not made by the specified date, you may experience a lapse in coverage or reimbursement for your test. According to the DEX Exchange, all molecular diagnostic tests will ultimately require a Z-Code assignment and technical assessment.

It is important for labs to understand if their Medicare Advantage Payor is requiring the DEX Z-Code. If your payor is requesting a Z-Code, it is important to submit your test to the DEX Exchange before the deadline. By submitting early, you will ensure there is no issues with getting a Z-Code assigned. However, enforcement of the Z-Code and test assessments will not occur until after the deadline.

Submitting before the deadline allows for:

  • Time to identify and fix possible errors in test submission to the DEX Exchange.
  • Time to identify and fix test limitations to prevent loss of reimbursement until deadline.
  • Time to register with the MolDX program.
    • There are 3 steps which include:
      1. Register with the DEX Exchange to participate in the MolDX program. Registration is completed on https://app.dexzcodes.com/. To register your lab, you will need your lab CLIA number and NPI number. Each lab can have 2 representatives assigned access. (10+ days)
      2. Register the Test. (2-3 weeks)
      3. Submit Technical Assessment. (6-8 weeks) [Clinical Validity + Clinical Utility + Clinical Accuracy]

If you need assistance navigating MolDX (which currently comprises Noridian, Palmetto, CGS, and WPS) or the DEX Z-Code process, feel free to contact us today for a free consultation.


Sharing is caring!