MedicaidCoverageMedium impact
FDA Cleared or Approved Companion Diagnostic Testing (for Idaho Only)
UnitedHealthcare·ID·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare Community Plan of Idaho (Medicaid) has updated its medical policy on FDA Cleared or Approved Companion Diagnostic Testing effective October 1, 2026. This policy establishes coverage guidelines for companion diagnostic tests used to identify patient populations most likely to benefit from specific therapeutics. Billing teams must review the complete policy details to understand which tests require prior authorization, documentation requirements, and any limitations on coverage.
Action Required
By September 30, 2026: Billing team must obtain and review the complete FDA Cleared or Approved Companion Diagnostic Testing policy from the provided URL. Identify which companion diagnostic tests (specific CPT/HCPCS codes) your practice performs and determine if prior authorization is required. Update billing system rules and encounter templates accordingly. Notify all providers and clinical staff of any new documentation or authorization requirements. Implement verification procedures to confirm test eligibility for Idaho Medicaid members before billing. Failure to comply may result in claim denials for non-compliant submissions.