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UnitedHealthcareMedicaid · Coverage · Medical Policy · NC · Cardiology, Internal Medicine, Family MedicineMedium impact

Cardiovascular Disease Risk Tests (for North Carolina Only)

Effective date
Dec 1, 2026
Identified
Oct 3, 2026

Summary

UnitedHealthcare Community Plan of North Carolina (Medicaid) is revising coverage for cardiovascular disease risk tests effective December 1, 2026. The policy removes coverage for advanced lipoprotein particle size/subfraction analysis and adds non-covered status for noninvasive point-of-care cardiac diagnostic platforms (e.g., CorVista System). CPT code 83695 has been removed from the applicable codes list. Billing teams must identify and deny claims for these services on or after the effective date.

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What to do

Action · 3 steps
01Before December 1, 2026: Billing team must update billing system edits to deny claims for CPT code 83695 (previously used for lipoprotein analysis) and any claims for CorVista or similar noninvasive point-of-care cardiac diagnostic platforms for UnitedHealthcare Community Plan (Medicaid) members in North Carolina.
02Update denial reason codes to reference the revised cardiovascular disease risk tests policy.
03Notify cardiology, internal medicine, and primary care providers of the coverage changes and direct them to patient financial counseling for self-pay options.
If missed: Failure to implement these edits will result in improper claim processing and potential recoupments.

Codes mentioned

83695

Original notice

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

Related changes

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Related policy hubs

UnitedHealthcare policiesNC policy changesCardiologyInternal MedicineFamily MedicineCode 83695

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