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Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions
Act
by Nov 1, 2026
Effective date
Dec 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare revised its molecular oncology testing policy for hematologic cancers, effective December 1, 2026. Key changes include: expanding multigene panel coverage to include suspected myeloproliferative neoplasm, adding mantle cell lymphoma to clonality assessment coverage, updating applicable CPT codes (adding 0332U and 0592U; removing 0485U, 0560U, 0561U), and clarifying that non-FDA-authorized companion diagnostic tests are now covered under this policy. The policy also designates specific tests as unproven (including EpiSwitch, optical genome mapping, and whole-transcriptome sequencing).
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What to do
by Nov 1, 2026 · 6 steps
01Billing team must update billing system to reflect code changes—add CPT codes 0332U and 0592U for covered molecular oncology testing and remove CPT codes 0485U, 0560U, and 0561U from reimbursable service lists.
02Update claim denial logic to approve multigene panel testing (up to 50 genes) when ordered by hematologist/oncologist for the seven specified hematologic cancers plus suspected myeloproliferative neoplasm at initial diagnosis or recurrence.
03Add mantle cell lymphoma and multiple myeloma to the approved list for clonoSEQ clonality assessment and measurable residual disease testing.
04Update internal guidelines and provider encounter forms to clarify that non-FDA-authorized companion diagnostic tests are now covered under this policy.
05Configure system to deny claims for unproven tests including EpiSwitch Checkpoint Inhibitor Response Test, optical genome mapping, and whole-transcriptome sequencing for hematologic cancer.
06Providers must be notified of code transitions to prevent billing delays and claim rejections.
Original notice
Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions
uhcprovider.com · Always check the source before changing claims.
Related changes
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