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UnitedHealthcareMedicaid · Billing Codes · Medical Policy · NJ · Hematology, Oncology, PathologyMedium impact

Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions (for New Jersey Only)

Effective date
Jan 1, 2027
Identified
Nov 7, 2026

Summary

UnitedHealthcare Community Plan of New Jersey revised its Medicaid medical policy for molecular oncology testing in hematologic cancers, effective 2027-01-01. Multigene panel testing of up to 50 genes is covered when ordered by a hematologist or oncologist at initial diagnosis or relapse for listed conditions (adding mantle cell lymphoma), clonoSEQ clonality and MRD testing is covered for listed conditions, and CPT codes 0332U, 0592U, 0644U and 0645U were added while 0485U, 0560U and 0561U were removed; all other molecular oncology testing is stated as unproven and not medically necessary, including EpiSwitch Checkpoint Inhibitor Response Test, optical genome mapping and whole-transcriptome sequencing.

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What to do

Action · 3 steps
01By 2027-01-01: Billing team and ordering providers should confirm that hematologic molecular tests are ordered by a hematologist or oncologist at initial diagnosis or relapse and that the diagnosis is one of the listed conditions before scheduling multigene panels, comprehensive genomic profiling or clonoSEQ testing.
02In charge entry, update the CPT code list so 0332U, 0592U, 0644U and 0645U are added and 0485U, 0560U and 0561U are removed, and note that 0332U, 0592U, 0644U and 0645U are not on the New Jersey Medicaid fee schedule and may not be covered.
03Tell providers and front desk staff that molecular tests outside the listed proven criteria, such as EpiSwitch, optical genome mapping and whole-transcriptome sequencing, are stated as unproven and not medically necessary, so these orders should be reviewed before scheduling; claims for these services may be denied under the revised policy.

Original notice

Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions (for New Jersey Only)
uhcprovider.com · Always check the source before changing claims.
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