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UnitedHealthcareMedicaid · Coverage · Medical Policy · OH · Cardiology, Internal Medicine, General PracticeMedium impact

Cardiovascular Disease Risk Tests (for Ohio Only)

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

Summary

UnitedHealthcare Community Plan of Ohio has revised its Cardiovascular Disease Risk Tests policy to clarify unproven and not medically necessary indications, specifically adding noninvasive point-of-care cardiac diagnostic platforms (e.g., CorVista® System) to the non-covered list and removing CPT code 83695 from coverage. Effective December 1, 2026, Ohio Medicaid providers must stop billing for these tests and update denial protocols accordingly.

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What to do

by Nov 30, 2026 · 5 steps
01Billing team must update the billing system to deny and reject CPT code 83695 for UnitedHealthcare Community Plan of Ohio (Medicaid) members.
02Update charge entry templates to prevent providers from ordering cardiovascular risk tests including arterial compliance testing, endothelial function assessment (PAT, brachial artery ultrasound), multiprotein biomarker panels, and CorVista® System platforms.
03Add alert messaging in EMR/billing software to notify providers that these tests are non-covered effective December 1, 2026.
04Educate cardiology and internal medicine providers about policy change to prevent claim denials.
05All claims submitted after 2026-12-01 for these services on Ohio Medicaid will be denied as not medically necessary.

Codes mentioned

83695

Original notice

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

Related changes

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Related policy hubs

UnitedHealthcare policiesOH policy changesCardiologyInternal MedicineGeneral PracticeCode 83695

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