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Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions (for Kentucky Only)
Effective date
Jan 1, 2027
Identified
Nov 7, 2026
Summary
Effective 2027-01-01, UnitedHealthcare Community Plan of Kentucky (Medicaid) revised its molecular oncology testing policy for hematologic cancers. Kentucky members' medical necessity is now referred first to Kentucky Revised Statutes § 304.17A-263 biomarker testing criteria, and the policy adds clonoSEQ clonality/MRD coverage, lists specific proven multigene panel and comprehensive genomic profiling uses, and names EpiSwitch Checkpoint Inhibitor Response Test, optical genome mapping and whole-transcriptome sequencing as unproven.
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What to do
Action · 3 steps
01By 2027-01-01: Billing team and providers should review hematology and oncology orders for Kentucky UnitedHealthcare Community Plan members, confirm the ordering clinician is a hematologist or oncologist and the indication matches the listed conditions, and document diagnosis, timing (initial diagnosis, recurrence or relapse) and medical necessity in the order notes.
02Update charge entry and claim edits so CPT 0332U, 0592U, 0644U and 0645U are billed only with supporting documentation, and stop scheduling EpiSwitch Checkpoint Inhibitor Response Test, optical genome mapping or whole-transcriptome sequencing for these members, since claims for unproven tests will be denied as not medically necessary.
03Tell front desk staff and providers about the change before January 2027 so orders are routed correctly.
Original notice
Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions (for Kentucky Only)
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions (for New Mexico Only)MediumEffective Jan 1, 2027 · Medical PolicyMolecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions (for New Jersey Only)MediumEffective Jan 1, 2027 · Medical PolicyWhole Exome and Whole Genome Sequencing (Non-Oncology Conditions) (for Kentucky Only)MediumEffective Jan 1, 2027 · Medical PolicyMolecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment DecisionsMediumEffective Jan 1, 2027 · Medical PolicyBrowse every UnitedHealthcare change in the policy list