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Why a Z-Code Identifier Doesn’t Equal MolDX Reimbursement

By: Tami Shaw, Client Manager, RCM Solutions

In the Spring of 2022, states participating in a Medicare MAC utilizing the MolDX program were subject to changes requiring registration for Infectious Disease testing if the panel in question is a lab developed test (LDT).

The first step for anyone new to the process is to register with the DEX Diagnostic Exchange Registry.

To do so, you will need your lab’s CLIA number and NPI number. Only two users are allowed per lab, so determine who those two will be before starting the process. Once registration is complete it can take up to 10 days to receive a login. You successfully registered the lab with the DEX Exchange when you receive your login.

 

Register your tests

The next step is to register your tests. All LDT tests will need to be registered. The test registration process will ask for some basic information about your test.

Within approximately two weeks the DEX Exchange will assign a Z-code identifier. This code establishes the connection between your lab and the tests you registered. However, it does not indicate approval for reimbursement. It is simply an identifier of your lab and registered tests.

 

Technical Assessment

The next step will be a Technical Assessment. The DEX Exchange will request it, if it is required, and response to the request is limited to 15 days for submission. The Technical Assessment is a much more detailed request than initial information provided during registration. It can take several months for a determination to be made on the submitted technical assessment.

After a thorough analysis of the technical assessment, if it is approved, the DEX Exchange will assign what CPT codes are to be used when submitting the claim, as well as an assigned reimbursement. Once you have this information it can be added to the claims you submit. Your lab-specific code (Z-Code Identifier) and the assigned CPT code will go together on the claim.

For Example: ZCODE EXAMPLE + 87999 (Your Lab Identifier) (Your Assigned CPT) = Assigned Reimbursement

On Paper claims, this would go into Box 19. On Electronically submitted claims this would go onto Loop 2400 or SV101-7.

 

If you need assistance with navigating MolDX reimbursement or the Technical Assessment process, contact us today for a free consultation.

 

 

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