Medicaid Coverage and Coding Guides

Policies for UHC Community Plan

Below is a list of Medicaid coverage policies for certain tests or test groups. Certain tests or test groups may follow Medicare coverage policies. Click on the link(s) to find the coverage limitations and indications for the test you want to order.

UHC Community Plan Limited Coverage List

Acute hepatitis panel

Alpha-fetoprotein (AFP); serum

Carcinoembryonic antigen (CEA)

Collagen crosslinks, any method

Digoxin; total

Ferritin

Fibrotest - Add-On Codes Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Add-On Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Hepatitis Screening – Community Plan Medical Policy

Fibrotest - Hepatitis Screening (for Louisiana Only) – Community Plan Medical Policy

Fibrotest - Hepatitis Screening (for Nebraska Only) – Community Plan Medical Policy

Fibrotest - Hepatitis Screening (for New Jersey Only) – Community Plan Medical Policy

Fibrotest - Hepatitis Screening (for Tennessee Only) – Community Plan Medical Policy

Fibrotest - Laboratory Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Molecular Diagnostic Infectious Disease Testing – Medicare Advantage Policy Guideline

Fibrotest - Maximum Frequency Per Day Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Non-Covered and Covered Codes Policy, Facility for Louisiana - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Non-Covered Codes and Covered Codes Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Non Covered and Covered Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Procedure to Place of Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Professional / Technical Component Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Professional/Technical Component Policy, Professional for Louisiana - Reimbursement Policy - UnitedHealthcare Community Plan

Fibrotest - Viral Hepatitis Serology Testing Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan

Glutamyltransferase, gamma (GGT)

Glycated Hemoglobin/Glycated Protein)

Human Chorionic Gonadotropin (hCG)

Lipids Testing

Partial Thromboplastin Time (PTT)

Prostate

Prothrombin Time (PT)

Serum Iron

Thyroid Testing

Tumor Antigen by Immunoassay CA 125

Tumor Antigen by Immunoassay CA 19-9

Tumor Antigen by Immunoassay CA15-3/CA 27.29

Urine Culture, Bacterial

Vitamin D Testing

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