CurrentUnitedHealthcarePolicy N/A

Serum hepcidin and related diagnostic testing reimbursement

Defines UnitedHealthcare Community Plan Medicaid reimbursement stance and methodology for diagnostic tests related to iron homeostasis and metabolism, including hepcidin and certain glycosylated protein assays; applies to providers billing on CMS-1500 and UB-04 for Community Plan Medicaid products.

Policy Summary

PayerUnitedHealthcare

PolicySerum hepcidin and related diagnostic testing reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProviders must submit accurate claims and bill using codes that correctly describe services provided.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

0024U, 0251UProcedure codes listed in policy

National w/ exceptionsGeographic applicability

UB-04 & CMS-1500Forms to which policy applies

Coverage Exclusions and Criteria

Coverage exclusions

UnitedHealthcare Community Plan will not consider reimbursement for the following tests related to iron homeostasis and metabolism.

The following tests are not considered for reimbursement:

Tests

Serum hepcidin testing, including immunoassays
GlycA testing to monitor transferrin or other glycosylated proteins for iron homeostasis and metabolism

Procedure codes listed in this policy are associated with the tests above and are not covered under this policy; see state exceptions for applicability.

Procedure codes

Policy Summary

PayerUnitedHealthcare

PolicySerum hepcidin and related diagnostic testing reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProviders must submit accurate claims and bill using codes that correctly describe services provided.

SourceLink

On This Page

Procedure Codes and Coding Notes

Procedure codes referencedCPTNot Covered

0024U	Listed test code referenced in policy
0251U	Listed test code referenced in policy

Reimbursement inclusion note

Scope of procedure codesProcedure codes appearing in this policy are included only as a general reference and may not be all-inclusive.

Implication for billingProviders must verify coding and not assume the policy lists every applicable code; use codes that accurately describe services provided.

Reference usageCodes shown in the policy are a tool for reference — confirm code applicability with payer-specific guidance and state exceptions.

Claims Submission & Provider Responsibilities

Billing Rule

Claims Submission Responsibility

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 uses Current Procedural Terminology (CPT®), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines for definitional purposes; references do not guarantee reimbursement. This policy applies to services billed on CMS 1500 forms and, when specified, UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design, and other factors are considered in developing reimbursement policy. Other factors (for example, federal or state regulatory requirements, provider contracts, the enrollee's benefit coverage documents, and other reimbursement, medical or drug policies) may supplement, modify, or supersede this policy. UnitedHealthcare may use reasonable discretion in interpreting and applying this policy to services in a particular case and may modify the policy at any time by publishing a new version. Providers should bill using codes that correctly describe the services provided and follow applicable coding guidelines; failure to submit accurate, appropriately-coded claims may result in denial or incorrect reimbursement.

Applies to claims billed on CMS 1500 and, when specified, UB04 forms
Follow CPT, CMS, and other coding guidelines; CPT is a trademark of the AMA
Other regulatory, contractual, and benefit-design factors may affect reimbursement
UnitedHealthcare may interpret or modify policy and systems may implement policies differently

OpenPayer

Serum hepcidin and related diagnostic testing reimbursement

Coverage Exclusions and Criteria

Procedure Codes and Coding Notes

Claims Submission & Provider Responsibilities

Diagnostic Testing Definitions