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Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions
Act
by Dec 1, 2026
Effective date
Dec 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare Surest updated its molecular oncology testing policy for hematologic cancers, effective December 1, 2026. Key changes include: expanded coverage for multigene panel testing (up to 50 genes) to include T-cell lymphoma, suspected myelodysplastic syndrome, and suspected myeloproliferative neoplasm; added mantle cell lymphoma to clonality assessment/measurable residual disease coverage; added CPT codes 0332U and 0592U; removed CPT codes 0485U, 0560U, and 0561U; and designated EpiSwitch Checkpoint Inhibitor Response Test, optical genome mapping, and whole-transcriptome sequencing as unproven/not medically necessary.
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What to do
by Dec 1, 2026 · 5 steps
01Billing team must update billing system to ADD CPT codes 0332U and 0592U to the allowed list for covered molecular oncology testing.
02Remove CPT codes 0485U, 0560U, and 0561U from the allowable billing codes for Surest plans—claims using these codes will be denied.
03Update authorization/edits logic to allow multigene panel testing (up to 50 genes) when ordered by hematologist/oncologist for the expanded list of conditions (now including T-cell lymphoma, suspected myelodysplastic syndrome, suspected myeloproliferative neoplasm).
04Configure system to deny coverage for EpiSwitch Checkpoint Inhibitor Response Test, optical genome mapping, and whole-transcriptome sequencing as unproven tests.
05Providers must be notified of code changes and expanded coverage criteria to ensure proper ordering.
If missed: Failure to implement will result in claim denials for valid tests and inappropriate payment for non-covered tests.
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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