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Cardiovascular Disease Risk Tests (for Kentucky Only)
Act
by Nov 1, 2026 (30 days before effective date)
Effective date
Dec 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare Kentucky Medicaid updated its cardiovascular disease risk testing policy effective December 1, 2026, narrowing coverage exclusions for lipoprotein analysis and adding new non-covered technologies including CorVista cardiac diagnostic platforms. CPT code 83695 was removed from the policy, and the policy now references Kentucky state statutes for medical necessity determination. Billing teams must immediately update denial logic and prior authorization workflows to reflect these changes.
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What to do
by Nov 1, 2026 (30 days before effective date) · 9 steps
01Billing team must.
02Remove CPT code 83695 from all billing software and claim submission systems.
03Update denial reason codes and automated billing rules to deny claims for the newly listed unproven tests, specifically: subfractions/particle size lipoprotein analysis, CorVista System and CorVista System with CAD/PH add-ons, and all multiprotein diagnostic biomarkers listed in the policy.
04Implement requirement that all cardiovascular risk testing claims first reference Kentucky Revised Statutes § 304.17A-263 for medical necessity before applying the policy's exclusion criteria.
05Configure prior authorization workflows to route CorVista and advanced lipoprotein testing claims to medical review rather than automatic approval.
06Notify in-network providers (cardiology, internal medicine, family medicine) of the narrowed coverage scope via bulletin or provider portal.
07Update claim denial templates to cite the specific policy exclusion.
08Failure to implement by the effective date will result in incorrect claim payments or denials.
09Audits should begin in January 2027 to identify and correct any paid claims for excluded services.
Codes mentioned
83695
Original notice
Cardiovascular Disease Risk Tests (for Kentucky Only)
uhcprovider.com · Always check the source before changing claims.
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