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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 cancers effective December 1, 2026. Key changes include: expansion of multigene panel testing criteria to include suspected myeloproliferative neoplasm, addition of mantle cell lymphoma to comprehensive genomic profiling and measurable residual disease coverage, removal of three CPT codes (0485U, 0560U, 0561U) and addition of two new codes (0332U, 0592U), and designation of EpiSwitch Checkpoint Inhibitor Response Test as unproven. Billing teams must immediately update software to reflect new covered/non-covered tests and applicable billing codes.
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What to do
by Nov 30, 2026 · 8 steps
01Billing team must update the billing system to reflect all policy changes effective December 1, 2026.
02Remove CPT codes 0485U, 0560U, and 0561U from coverable codes list—flag any pending/recent claims using these codes for potential rework before effective date.
03Add CPT codes 0332U and 0592U as covered services when medical necessity criteria are met.
04Update authorization rules to require prior authorization for multigene panel testing (up to 50 genes) only when ordered by hematologist/oncologist at initial diagnosis or recurrence/relapse for specified hematologic cancers.
05Update system to mark the following as UNPROVEN/NOT COVERED: EpiSwitch Checkpoint Inhibitor Response Test, optical genome mapping, whole-transcriptome sequencing, and all other molecular oncology tests not explicitly listed in policy.
06Add mantle cell lymphoma to approved conditions for comprehensive genomic profiling and clonoSEQ measurable residual disease detection.
07Update encounter templates and prior authorization forms to reflect new approved indications and removed codes.
08Provider education team should notify oncologists and hematologists of expanded coverage for suspected myeloproliferative neoplasm.
If missed: Failure to implement changes will result in claim denials for services performed after December 1, 2026 using deleted codes or without proper authorization.
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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