- Home
- Advocacy
- Latest News and Practice Data
- CAP Opposes UnitedHealthcare Coding Policy Going into Effect April 1
UnitedHealthcare has announced that its new Z-code requirement for certain genetic test claims will become effective on April 1, 2024. 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 announced the Z-code requirement was going to be implemented in August 2023. However, the CAP met with UnitedHealthcare and was successful in getting them to delay this requirement until the new date, April 1. The CAP is currently working on scheduling a follow-up meeting with UnitedHealthcare leaders to get more information and continue to express our concerns.
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. Non-standard coding practices have serious negative consequences for pathologists and laboratories trying to implement conflicting requirements.
Additionally, the CAP supports the continued use of the CPT code set as it is developed with broad stakeholder input and provides a uniform language that accurately describes medical, surgical, and diagnostic services provided by physicians and other qualified healthcare professionals. The CAP believes that the CPT process would be the appropriate method for insurers to address any issues with information on specific tests and it would not add further requirements and reporting complexity for pathologists.
The CAP will continue to engage with UnitedHealthcare on this new requirement and will update membership on any developments. Read more.