CurrentColorado Rocky Mountain Health PlansPolicy 2026R8223A

Reimbursement for multianalyte serum testing for hepatic fibrosis

Defines reimbursement methodology and frequency limits for serum multianalyte assay testing to distinguish hepatic cirrhosis from non-cirrhosis for UnitedHealthcare Medicare Advantage enrollees, and applies to services billed on UB04 or CMS 1500 forms.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement for multianalyte serum testing for hepatic fibrosis

Policy CodePolicy 2026R8223A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionVerify member benefits and submit accurate claims; check enrollee benefit documents or customer service for coverage specifics.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

every 6 monthsallowed frequency per member

2 coveredreimbursable codes

5 listednon-reimbursable codes

4 listedclinical indications

Reimbursement Criteria

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Reimbursement criteria for hepatic fibrosis multianalyte assays

Covered when ALL of the following are met:

ALL of the following

Procedure is one of the reimbursable multianalyte assay testing codes: 81517 or 81596.
Test is being used to distinguish hepatic cirrhosis from non-cirrhosis.
ALL of the following
- Applicable clinical indication (ONE of)
  - Hepatitis B.
  - Hepatitis C.
  - Metabolic dysfunction-associated steatotic liver disease (MASLD), including metabolic dysfunction-associated steatohepatitis (MASH).
  - Alcoholic hepatitis.
- Frequency limitation: One unit every 180 calendar days (once every six months) per member.
  Frequency limitation applies regardless of billing and/or rendering provider for the same date of service.

Frequency limitation is applicable regardless of billing and/or rendering provider (any individual provider or any facility) for each individual member for the same date of service.

Procedure Codes and Frequency Limits

Reimbursable multianalyte assay codesmixedCovered

81517	81517
81596	81596

Non-reimbursable multianalyte assay codesmixedNot Covered

0002M	0002M
0003M	0003M
0166U	0166U
0344U	0344U
0468U	0468U

Frequency limit

Frequency limitOne unit every 180 calendar days (once every six months)

Application per memberLimit applies per member regardless of billing or rendering provider for the same date of service

Unit allowanceMaximum of 1 unit may be reimbursed within any 180-calendar-day period

Billing and Authorization Notes

Prior Authorization

Prior authorization and claim submission responsibilities

This policy does not include notations regarding prior authorization requirements; providers are responsible for submission of accurate claims and should check enrollee benefit documents or customer service for coverage specifics.

Verify enrollee benefit coverage and any prior authorization requirement by calling the number on the member ID card or checking benefit documents.
Submit accurate claims using the code(s) that correctly describe the services performed on UB04 (CMS 1450) or CMS 1500 forms or electronic equivalents.

Scope and Definitions

Application

Plan scopeApplies to all Medicare Advantage products

Claim forms allowedServices reported using UB04 (CMS 1450) and CMS 1500 forms or their electronic equivalents

Provider networkApplies to network provider services

Once every six months — definition

Definition of intervalOnce every six months = One unit every 180 calendar days

Frequency interpretationCount days from date of service; subsequent reimbursement allowed only after 180 calendar days have elapsed

Scope of definitionApplies to multianalyte assay reimbursement frequency described in this policy