Summary
UnitedHealthcare's November 2026 Exchange bulletin, effective 2027-01-01, adds coverage language that several services (3D model creation from surface mesh files, CRISPR-based TB plasma/serum analysis, multianalyte Alzheimer/dementia lab tests, photobiomodulation for AMD, meibomian gland evaluation/evacuation incl. CPT 17999, histotripsy incl. CPT 1037T, and percutaneous gastrostomy with magnetic gastropexy) is unproven and not medically necessary, and revises criteria for irreversible electroporation, BeScreened-CRC, BIOTIA-ID, IVD CAPSULE PSP, external urine management systems (HCPCS E2001), noninvasive bimodal neuromodulation (E1399), and sacral Tarlov cyst surgery (63268, which now requires failure of conservative multidisciplinary management rather than 12 weeks of non-surgical treatment). Billing teams should hold these services for Exchange members as of 2027-01-01 and update charge entry and claim edits accordingly.
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