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UnitedHealthcareAll Plans · Coverage · Medical Policy · Hematology, Oncology, PathologyHigh impact

Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions

Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Oct 3, 2026

Summary

UnitedHealthcare revised its molecular oncology testing policy for hematologic cancer diagnosis effective December 1, 2026. Key changes include: expanded coverage for multigene panel testing (up to 50 genes) at initial diagnosis or recurrence when ordered by hematologist/oncologist; added mantle cell lymphoma and suspected myeloproliferative neoplasm to covered conditions; clarified that clonoSEQ is the only approved test for clonality assessment and measurable residual disease; added new unproven tests (EpiSwitch, optical genome mapping, whole-transcriptome sequencing); and updated applicable billing codes (added 0332U, 0592U; removed 0485U, 0560U, 0561U).

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What to do

by Nov 30, 2026 · 7 steps
01Billing team must update billing system to add CPT codes 0332U and 0592U to covered molecular oncology testing for hematologic cancer.
02Remove CPT codes 0485U, 0560U, and 0561U from billable codes and flag any pending claims.
03Update prior authorization logic to require hematologist or oncologist ordering for multigene panel testing coverage.
04Providers must document whether testing is at initial diagnosis, recurrence, or relapse for coverage determination.
05Verify all hematologic cancer diagnoses (AML, ALL, lymphomas, CML, multiple myeloma, MDS, MPN) are accurately coded on encounter forms to ensure proper coverage eligibility.
06Training required: Educate front-desk and billing staff that clonoSEQ is the only allowed test for measurable residual disease assessment—deny claims for competing MRD tests.
07Denial consequences: Claims submitted with removed codes or without required provider specialty documentation will be denied and require rework.

Original notice

Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions
uhcprovider.com · Always check the source before changing claims.
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Related changes

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