UnitedHealthcare (UHC) has announced upcoming significant changes that will directly impact reimbursement for routine laboratory testing. 

Beginning December 1, 2025, UHC will implement new reimbursement policies for Commercial, Individual Family Plans, and Medicare Advantage Plans. Per UnitedHealthcare’s Reimbursement Policy Update Bulletin for September 2025 :

Effective December 1, 2025, 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 for which claims for these tests will be considered for reimbursement.

 These policies will deny reimbursement when procedure codes do not align with the corresponding diagnoses or when tests exceed the frequency limits. In a major shift in how routine lab services will be reimbursed by UHC, claims will undergo stricter review of diagnostic alignment, medical necessity, and frequency.

Key Examples from UHC’s Bulletin

  • “UnitedHealthcare will not consider reimbursement of Serum hepcidin testing, including immunoassays and GlycA testing…”
  • “UnitedHealthcare will consider reimbursement of serum lipase concentration procedure codes for the initial determination of acute pancreatitis, no more than once per week, when billed for specific conditions (abdominal pain, nausea and vomiting, fever, hypotension, anorexia, ileus, and pancreatitis).”

Example Tests & Services Impacted:

  • Flow Cytometry
  • Diabetes Mellitus Testing (A1c)
  • Diagnostic Testing of Iron Homeostasis & Metabolism
  • Pancreatic Enzyme Testing (acute pancreatitis)
  • Prostate Biopsy Specimen Analysis
  • Fecal Analysis for Intestinal Dysbiosis & Fecal Microbiota Transplant Testing
  • Diagnostic Testing of Influenza
  • Testing of Homocysteine Metabolism-Related Conditions
  • Lyme Disease Testing
  • Bone Turnover Markers Testing
  • Fecal Calprotectin Testing in Adults
  • Immune Cell Function Assay
  • Laboratory Testing for Inflammatory Bowel Disease
  • Onychomycosis Testing
  • Biomarker Testing for Autoimmune Rheumatic Disease
  • Biomarkers for Myocardial Infarction & Chronic Heart Failure
  • Epithelial Cell Cytology in Breast Cancer Risk Assessment
  • Intracellular Micronutrient Analysis

 For more information, Aculabs recommends clients visit uhcprovider.com for the latest updates from UnitedHealthcare.

For our most current billing information notices and guides, please visit our Billing Notices section.