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- Deadline for UnitedHealthcare Z-Code Compliance for Reimbursement April 1
The CAP met with officials from UnitedHealthcare to express our continued opposition and strong concern over the insurer’s decision to move forward with new requirements to use Z-codes beginning April 1, 2024. In response to questions from the CAP, UnitedHealthcare officials reviewed its plan to minimize disruption of pathology services and allow for some assistance for laboratories working to comply with the new requirements.
The CAP opposes this requirement for specific Z-code identifiers on claims to receive payment, as it would be confusing and result in complex workflow processes that will be difficult for CAP members, especially those unfamiliar with Palmetto. The CAP was successful in getting the insurer to delay this requirement from the original October 2023 date until the new implementation date of April 1. The Z-code requirement will initially cover 133 CPT codes and 104 proprietary laboratory analysis codes. Claims will be denied if the Z-code plus the appropriate CPT code information is missing.
UnitedHealthcare said they will provide the following to assist in the transition:
- “Provider advocates” who are engaged and monitoring labs and will reach out to help with the Z-code process.
- Increased communication with Palmetto and within hospital systems.
- A commitment to work collaboratively with providers to understand who are struggling with the new process.
Learn how to prepare for April 1 compliance here. For additional queries or issues with the Z-codes, UnitedHealthcare suggests emailing them at united_genetics@uhc.com.