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UnitedHealthcareMedicaid · Billing Codes · Medical Policy · OH · Cardiology, GeneticsMedium impact

Genetic Testing for Cardiac Disease (for Ohio Only)

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

Summary

UnitedHealthcare Community Plan of Ohio (Medicaid) revised its Genetic Testing for Cardiac Disease policy effective November 1, 2026. Key changes include: added HCPCS code S3865, updated cross-references to related policies (added Chromosome Microarray Testing and Genetic Testing for Neurological Disorders; removed Molecular Oncology Testing and Pharmacogenetic Panel Testing references), and clarified medical necessity criteria with updated InterQual® references for hereditary cardiomyopathy evaluation.

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What to do

by Nov 1, 2026 · 4 steps
01Billing team must update billing system to recognize and process HCPCS code S3865 for genetic testing related to cardiac disease.
02Update claim submission rules to reflect the new cross-references: remove denial rules tied to Molecular Oncology Testing and Pharmacogenetic Panel Testing policies for cardiac cases; add routing rules to direct isolated severe congenital heart disease cases to Chromosome Microarray Testing policy and neuromuscular cardiomyopathy cases to Genetic Testing for Neurological Disorders policy.
03Providers must update medical necessity documentation templates to align with revised InterQual® CP: Molecular Diagnostics criteria (specifically 'Hereditary Cardiomyopathy' instead of 'Genetic Testing for Hereditary Cardiomyopathy').
04Coding staff should review existing cardiac genetic testing claims submitted under old policy references and determine if rework is needed for Ohio Medicaid members.
If missed: Failure to implement these changes by the effective date will result in claim denials or rejections for S3865 and improperly referenced cardiac genetic testing claims.

Codes mentioned

S3865

Original notice

Genetic Testing for Cardiac Disease (for Ohio Only)
uhcprovider.com · Always check the source before changing claims.
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Related policy hubs

UnitedHealthcare policiesOH policy changesCardiologyGeneticsCode S3865

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