Labs Should Prepare for Arrival of ‘Perfect Storm’

By Robert Michel | From the Volume XXXI, No. 3 – February 26, 2024 Issue

CEO SUMMARY: In the near future, clinical labs and pathology groups will need to address three major developments. One involves the FDA proposed LDT rule. A second is the adoption by payers of guidelines that require genetic test claims to have Z-Codes. The third centers around coming ref…

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Year’s Top 10 Lab Stories Contain Surprises & Twists

By Robert Michel | From the Volume XXX, Number 18 – December 26, 2023 Issue

CEO SUMMARY: With the SARS-CoV-2 pandemic now in the rearview mirror of the nation’s clinical labs and pathology groups, the important news stories of 2023 were mostly about developments where the consequences will influence laboratory operations in coming years. Artificial intelligence…

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Private Health Insurers Are Aware of Problems with CPT Code 81408

By Virchow | From the Volume XXX, No. 13 – September 11, 2023 Issue

EDITOR’S NO…

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UHC Will Delay Enforcement of Z-codes for Genetic Test Claims

By Scott Wallask | From the Volume XXX, No. 13 – September 11, 2023 Issue

IN THE LATEST BACKPEDAL ON ITS NEW POLICY, UNITEDHEALTHCARE (UHC) appears to have dropped its requirement for genetic testing laboratories to use Z-codes for claims under commercial health plans—for now. Earlie…

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Technical Assessment Challenges for Z-Code Applications

By Scott Wallask | From the Volume XXX, No. 10 – July 10, 2023 Issue

CEO SUMMARY: Effective on Aug. 1, UnitedHealthcare will require Z-code submissions for many genetic tests. During a recent webinar, experts tackled a topic that may prove troublesome for labs seeking Z-codes: technical assessments. Key advice is to provide specific data about clin…

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UnitedHealthcare’s Z-code Policy Starts on Aug. 1

By Robert Michel | From the Volume XXX, No. 10 – July 10, 2023 Issue

CEO SUMMARY: UnitedHealthcare’s (UHC) response to the ever-growing number of unique genetic tests and the continuing growth in the volume of those claims is a new policy. Effective Aug. 1, UHC will require a Z-code with genetic test claims. This req…

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Stressful Weeks Ahead for Labs Thanks to Z-codes

By R. Lewis Dark | From the Volume XXX, No. 10 – July 10, 2023 Issue

We are not alone in recognizing that UnitedHealthcare’s…

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Optum and Avalon Discuss Genetic Test Claims Review

By Scott Wallask | From the Volume XXX, No. 9 – June 19, 2023 Issue

CEO SUMMARY: With the ever-increasing number of genetic tests on the market, payers are understandably frustrated with genetic test claims that don’t clearly outline the medical need for a procedure or it…

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Expect More Z-code Requirements for Genetic Tests

By R. Lewis Dark | From the Volume XXX, No. 9 – June 19, 2023 Issue

GENETIC TESTING COMPANIES ARE STILL REACTING TO LAST MONTH’S NEWS that one of the nation’s largest health insurers—UnitedHealthcare (UHC)—will require Z-codes for molecular test claims submitte…

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For Labs, a Little Angel and Devil Sit Behind Z-Codes

By R. Lewis Dark | From the Volume XXX, No. 8 – May 30, 2023 Issue

Much lies underneath the surface of UnitedHealthcare’s (UHC) new policy mandating Z-code use for molecular tests covered under its commercial health plans. It’s a developme…

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