CurrentUnitedHealthcarePolicy 2025R8211B

Medicare Advantage Reimbursement Policy — Onychomycosis Diagnostic Testing (NAAT and ATR-FTIR)

Defines UnitedHealthcare Medicare Advantage reimbursement methodology for diagnostic tests (NAAT and ATR-FTIR) related to onychomycosis for services billed on CMS 1500 and UB04 forms and who may be reimbursed.

Policy Summary

PayerUnitedHealthcare

PolicyMedicare Advantage Reimbursement Policy — Onychomycosis Diagnostic Testing

Policy CodePolicy 2025R8211B

Change TypePolicy language and code updatenew policy entry

Effective Date

Next Review Date

Key ActionSubmit accurate claims; NAAT may be reimbursed only if antifungal therapy has failed to resolve infection.

SourceLink

POLICY UPDATE CHANGES

Policy Language and Code update in Reimbursement Guidelines section

New Policy

2NAAT procedure codes listed

1ATR-FTIR code (not reimbursed)

3Document sections

Onychomycosis Diagnostic Testing Coverage

Onychomycosis diagnostic testing coverage

Reimbursement positions for diagnostic tests for onychomycosis:

ALL of the following

Test: Nucleic Acid Amplification Testing (NAAT) — Procedure codes: 87480, 87481
Coverage position: Covered when the clinical requirement is met
Clinical requirement: Anti-fungal therapy has failed to resolve infection

ALL of the following

Test: Attenuated total-reflectance Fourier transform infrared spectroscopy (ATR-FTIR) — Procedure code: 88749

Policy Summary

PayerUnitedHealthcare

PolicyMedicare Advantage Reimbursement Policy — Onychomycosis Diagnostic Testing

Policy CodePolicy 2025R8211B

Change TypePolicy language and code updatenew policy entry

Effective Date

Next Review Date

Key ActionSubmit accurate claims; NAAT may be reimbursed only if antifungal therapy has failed to resolve infection.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Procedure Codes and Coding Notes

NAAT codesCPTCovered

87480	87480
87481	87481

ATR-FTIR spectroscopyCPTNot Covered

88749

88749 - Attenuated total-reflectance Fourier transform infrared spectroscopy (ATR-FTIR)

Clinical prerequisite for NAAT reimbursement — failure of antifungal therapy to resolve infection

Clinical prerequisiteNAAT reimbursed only when antifungal therapy has failed to resolve infection

Applicable testNucleic Acid Amplification Testing (NAAT)

Policy scopeReimbursement consideration applies to individuals with onychomycosis

Action requiredDocumentation should support prior antifungal treatment failure when submitting claims

Claims Submission and Provider Responsibilities

Documentation Required

Claims submission and policy modification note

You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Medicare Advantage reimbursement policies use CPT®, CMS, or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This policy applies to services billed on UB04 (CMS 1450) and CMS 1500 forms (or their electronic equivalents). Other factors (for example: legislative mandates, provider contracts, the enrollee's benefit coverage documents, and other reimbursement, medical, or drug policies) may supplement, modify, or supersede this policy. UnitedHealthcare Medicare Advantage may use reasonable discretion in interpreting and applying this policy and may modify this reimbursement policy at any time to comply with changes in CMS policy and other national standard coding guidelines by publishing a new version of the reimbursement policy on this website.

Applicable forms: UB04 (CMS 1450) and CMS 1500 (or electronic equivalent)
Providers must follow CPT®, CMS, and other coding guidelines when submitting claims
Policy may be modified; check UnitedHealthcare website and CMS for updates

Billing Rule

NAAT reimbursement conditional

Nucleic acid amplification testing (NAAT) may be reimbursed for individuals with onychomycosis when antifungal therapy has failed to resolve the infection. Ensure documentation supports prior antifungal treatment and clinical necessity when submitting claims.

NAAT reimbursement condition: failure of antifungal therapy to resolve infection
Document prior antifungal therapy and clinical findings to support medical necessity

Definitions

NAAT — Nucleic Acid Amplification Testing (definition)

TermNucleic Acid Amplification Testing (NAAT)

DefinitionMolecular testing method to detect organism-specific nucleic acids for diagnosis of onychomycosis

Reimbursement stanceCovered with clinical prerequisite: considered when antifungal therapy has failed to resolve infection

Related codesCPT codes listed in policy: 87480, 87481 (see coding section)

ATR-FTIR — Attenuated total-reflectance Fourier transform infrared spectroscopy definition

TermAttenuated total-reflectance Fourier transform infrared spectroscopy (ATR-FTIR)

DefinitionSpectroscopic technique proposed to screen for, determine, or confirm onychomycosis

Reimbursement stanceWill not be considered for reimbursement to screen for, determine, or confirm onychomycosis