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


Glutamyltransferase, gamma (GGT)

Glycated Hemoglobin/Glycated Protein)

Human Chorionic Gonadotropin (hCG)

Lipids Testing

Partial Thromboplastin Time (PTT)


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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