Humana Z-Code Billing for Molecular Diagnostic Testing

Humana Claims Payment Policy  

Subject: Z-Code Billing for Molecular Diagnostic Testing   

Medicare Advantage Plan Palmetto Region 

The Molecular Diagnostic Services (MolDX) program maintains a coding system of Diagnostics Exchange (DEX®) Z-Codes® that identifies a specific molecular diagnostic test.  

This policy establishes Humana’s requirements for Z-Code billing for molecular diagnostic testing. 

Humana requires a provider to report a molecular diagnostic test with a unique DEX Z-Code, as assigned by MolDX, and the applicable Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) Level II code. Humana denies a molecular diagnostic test CPT or HCPCS code when it is not reported with the applicable DEX Z-Code.  

Providers should contact the MolDX program to register molecular diagnostic tests. 

References  

• Palmetto GBA website. MolDX® Program (Administered by Palmetto GBA). palmettogba.com. 
• Palmetto GBA website. Welcome to DEX® Diagnostics Exchange Registry. app.dexzcodes.com.