Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
UnitedHealthcareMedicaid · Coverage · Medical Policy · NM · Cardiology, Internal Medicine, Family Medicine +1 moreHigh impact

Cardiovascular Disease Risk Tests (for New Mexico Only)

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

Summary

UnitedHealthcare Community Plan of New Mexico (Medicaid) is revising its cardiovascular disease risk testing policy effective December 1, 2026. The policy narrows coverage by removing lipoprotein(a) testing from the unproven list (making it potentially coverable) while adding noninvasive point-of-care cardiac platforms like CorVista System to the non-covered list, and updating applicable CPT codes with a new quarterly edit code (1104T) and removal of code 83695.

Get alerts when payers change rules like this one

We check UnitedHealthcare and other payers every day and email you when a change matches your specialty and state.

Get UnitedHealthcare alertsPolicy Monitoring is free. No card required.

What to do

by Nov 30, 2026 · 6 steps
01Billing team must.
02Remove CPT code 83695 from all billing systems and encounter forms.
03Add CPT code 1104T with quarterly edit restriction to billing software for Medicaid claims in New Mexico only.
04Update claim scrubbing rules to deny or require prior authorization for all listed non-covered cardiovascular risk tests including subfractions/particle size lipoprotein analysis, carotid intima-media thickness, Lp-PLA2, endothelial function assessment, multiprotein biomarker panels, and noninvasive point-of-care cardiac diagnostic platforms (CorVista System).
05Alert providers in cardiology, internal medicine, and family medicine that lipoprotein(a) testing may now be covered (removed from unproven list) but all other advanced lipid panels and point-of-care cardiac platforms are not covered.
06Verify that billing system applies quarterly edit rules to 1104T to prevent overbilling.
If missed: Failure to implement these changes will result in claim denials for New Mexico Medicaid patients.

Codes mentioned

83695

Original notice

Cardiovascular Disease Risk Tests (for New Mexico Only)
uhcprovider.com · Always check the source before changing claims.
View original ↗

Related changes

See all UnitedHealthcare changes →
Cardiovascular Disease Risk Tests (for Pennsylvania Only)MediumEffective Dec 1, 2026 · Medical PolicyCardiovascular Disease Risk Tests (for Ohio Only)MediumEffective Dec 1, 2026 · Medical PolicyCardiovascular Disease Risk Tests (for North Carolina Only)MediumEffective Dec 1, 2026 · Medical PolicyCardiovascular Disease Risk Tests (for New Jersey Only)HighEffective Dec 1, 2026 · Medical PolicyBrowse every UnitedHealthcare change in the policy list

Related policy hubs

UnitedHealthcare policiesNM policy changesCardiologyInternal MedicineFamily MedicineGeneral PracticeCode 83695

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account