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UnitedHealthcareMedicaid · Coverage · Medical Policy · PA · Cardiology, Family Medicine, Internal Medicine +1 moreMedium impact

Cardiovascular Disease Risk Tests (for Pennsylvania Only)

Effective date
Dec 1, 2026
Identified
Nov 7, 2026

Summary

UnitedHealthcare Community Plan of Pennsylvania revised its Cardiovascular Disease Risk Tests medical policy for Pennsylvania Medicaid members, effective 2026-12-01. Subfractions or particle size advanced lipoprotein analysis is now listed as unproven and not medically necessary for cardiovascular risk, the list adds noninvasive point-of-care cardiac diagnostic platforms (such as CorVista) for predicting coronary artery disease, pulmonary hypertension, or pulmonary capillary wedge pressure, and CPT 83695 has been removed from the applicable codes.

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What to do

Action · 2 steps
01By 2026-12-01: Billing team should review scheduled and planned cardiovascular risk testing for Pennsylvania Medicaid members, stop scheduling or billing subfractions/particle size advanced lipoprotein analysis and the newly listed point-of-care cardiac diagnostic platforms (e.g., CorVista) for these members, and remove CPT 83695 from charge entry and claim edits for those services.
02Tell providers and front desk staff about the change before it takes effect, and note that services listed as unproven and not medically necessary are expected to be denied for these members, so discuss coverage expectations with patients before performing them.

Codes mentioned

83695

Original notice

Cardiovascular Disease Risk Tests (for Pennsylvania Only)
uhcprovider.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

UnitedHealthcare policiesPA policy changesCardiologyFamily MedicineInternal MedicinePathologyCode 83695

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