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Cardiovascular Disease Risk Tests (for New Jersey Only)
Act
by Nov 30, 2026
Effective date
Dec 1, 2026
Identified
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of New Jersey (Medicaid) revised its coverage policy for cardiovascular disease risk tests, effective December 1, 2026. The policy narrowed the exclusion for advanced lipoprotein analysis (now excluding only subfractions/particle size, not lipoprotein(a)), added exclusion for noninvasive point-of-care cardiac diagnostic platforms using machine learning (e.g., CorVista System), updated applicable CPT codes, and removed CPT 83695 from the billable codes list.
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What to do
by Nov 30, 2026 · 8 steps
01Billing team must.
02Remove CPT 83695 from all billing systems and encounter forms for NJ Medicaid claims.
03Add CPT 1104T with quarterly edit flag to billing system.
04Update claim submission rules to DENY coverage for: subfractions/particle size advanced lipoprotein analysis, noninvasive point-of-care cardiac diagnostic platforms (CorVista System and add-ons), arterial compliance testing, carotid intima-media thickness measurement, Lp-PLA2 enzyme testing, endothelial function assessment (PAT, brachial artery ultrasound), and multiprotein diagnostic biomarker panels listed in policy.
05Update clinical billing documentation checklist to reflect these exclusions.
06Train billing staff and providers on the revised coverage criteria for NJ Medicaid members only.
07Failure to implement will result in claim denials and potential revenue loss.
08Flag all affected claims submitted on or after 12/1/2026 for manual review until system updates are complete.
Codes mentioned
83695
Original notice
Cardiovascular Disease Risk Tests (for New Jersey Only)
uhcprovider.com · Always check the source before changing claims.
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