UnitedHealthcare has released an updated version of its Cardiovascular Disease Risk Tests medical policy for Commercial and Individual Exchange plans, effective November 1, 2026. This policy mostly lists cardiovascular risk tests that UHC considers unproven and not medically necessary. The latest revision includes a change laboratories performing lipid testing should know about.
What changed
Lipoprotein(a) is no longer listed as unproven. The previous policy named “advanced lipoprotein analysis,” including lipoprotein(a), subfractions, and particle size, as an unproven method to determine cardiovascular disease risk. The new version narrows that language to subfractions or particle size analysis only. Lipoprotein(a) is no longer named.
CPT 83695 removed. To match this change, UHC removed CPT code 83695 (Lipoprotein(a)) from the policy’s list of applicable codes.
New non-covered technology added. UHC added noninvasive point of care cardiac diagnostic platforms that use machine learning to predict cardiovascular disease, such as the CorVista® System and its CAD and PH add-ons, to the list of unproven and not medically necessary indications.
What this means for labs
Because 83695 is no longer on this policy’s non-coverage list, Lp(a) claims for UHC Commercial and Exchange members should no longer be denied under this policy. Standard claim requirements, medical necessity, and plan-specific benefits still apply. Labs should review their claim edits and payer rules before the November 1 effective date.
Policy links
- Sarah Stewart, Vice President, RCS