UnitedHealthcare is rolling out new reimbursement limits on five categories of lab tests across its commercial, ACA, Medicare Advantage and Medicaid plans.
The five policies cover allergen testing, liver fibrosis testing, in vitro chemotherapy sensitivity assays, testosterone blood tests and vitamin B12 testing.
The policies generally take effect Sept. 1 for commercial, exchange and MA plans, though several states have an effective date of Oct. 1 in the commercial and exchange markets. The Medicaid rollout is staggered by state, with effective dates ranging from August through November.
Broadly, the policies set frequency caps or exclude specific test types from reimbursement. The allergen testing policy caps specific IgE testing at 20 allergen-specific antibodies per year and excludes several testing methods, including ALCAT and bead-based epitope assays. The liver fibrosis policy limits multianalyte assay testing to once every six months for patients with hepatitis B, hepatitis C, MASLD or alcoholic hepatitis. The in vitro chemotherapy assays policy will not reimburse chemosensitivity and resistance assays at all. The testosterone policy will continue to cover testing for patients with defined clinical indications but will not reimburse testing for asymptomatic patients or those with nonspecific symptoms. The vitamin B12 policy caps total testing at once every three months.
The Medicaid bulletin also adds more than a dozen additional lab and diagnostic testing policies, including new reimbursement limits or exclusions for hemoglobin A1c testing, Lyme disease testing, influenza testing, flow cytometry, fecal calprotectin, intestinal dysbiosis testing, bone turnover markers for osteoporosis, a chronic heart failure biomarker assay and inflammatory bowel disease algorithm-based tests. Effective dates and affected states vary by policy.
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