Routine Laboratory Testing Policies
UnitedHealthcare announced it will implement new reimbursement policies for specific laboratory services, tests, and procedures, effective for dates of service on or after December 1, 2025 for all states except the following:
- Arkansas, Kentucky, and Ohio – February 1, 2026
- Colorado – March 16, 2026
- North Carolina, Nebrask,a and Rhode Island – UHC will issue a notification later for these states
UnitedHealthcare will apply automated post-service, pre-payment policy enforcement to claims reporting laboratory services performed in office, hospital outpatient, and independent laboratory locations. These policies will provide guidelines around the circumstances and frequency with which claims for these tests will be considered for reimbursement.
These policies will not apply to laboratory services, tests, and procedures provided in emergency rooms, hospital observation units, and hospital inpatient settings.
Routine Testing Management Policies:
- Flow Cytometry Policy, Professional and Facility
- Diabetes Mellitus Testing Policy, Professional and Facility
- Iron Homeostasis and Metabolism Policy, Professional and Facility
- Enzyme Testing for Acute Pancreatitis Policy, Professional and Facility
- Prostate Biopsy Specimen Analysis Policy, Professional and Facility
- Intestinal Dysbiosis and Fecal Microbiota Transplant Testing Policy, Professional and Facility
- Diagnostic Testing for Influenza Policy, Professional and Facility
- Homocysteine Testing for Metabolism Policy, Professional and Facility
- Lyme Disease Testing Policy, Professional and Facility
- Bone Turnover Marker Testing of Osteoporosis Policy, Professional and Facility
- Fecal Calprotectin Testing Policy, Professional and Facility
- Autoimmune Rheumatic Disease Policy, Professional and Facility
- Diagnostic Testing for Inflammatory Bowel Disease Policy, Professional and Facility
- Onychomycosis Testing Policy, Professional and Facility
- Immune Cell Function Assay Policy, Professional and Facility
- Chronic Heart Failure Policy, Professional and Facility
- Epithelial Cell Cytology Policy, Professional and Facility
- Intracellular Micronutrient Analysis Policy, Professional and Facility
MSN monitors policy updates and will communicate updates as they are released.
