TL;DR: UnitedHealthcare modified its Omnibus Codes Medicare Advantage Medical Policy (omnibus-codes-mamp), effective February 2, 2026. Billing teams need to check their charge capture for every unlisted or miscellaneous code they route through UHC Medicare Advantage — this policy governs what happens when no NCD, LCD, or LCA applies.
UnitedHealthcare updated the omnibus-codes-mamp coverage policy to clarify how it handles codes that fall outside any existing CMS National Coverage Determination or Local Coverage Determination. The policy explicitly routes these codes through UHC's own medical necessity review framework, and for a large set of codes — including 0061U, 0163U, 0174T, 0175T, 0207T, and 0208T — the conclusion is already written: not reasonable and necessary. If your billing team is submitting these codes to UHC Medicare Advantage and expecting reimbursement, this update closes that door officially.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | UnitedHealthcare |
| Policy | Omnibus Codes – Medicare Advantage Medical Policy |
| Policy Code | omnibus-codes-mamp |
| Change Type | Modified |
| Effective Date | February 2, 2026 |
| Impact Level | High |
| Specialties Affected | Oncology, ophthalmology, audiology, vascular surgery, wound care, radiology |
| Key Action | Audit all claims for codes listed in omnibus-codes-mamp before submitting to UHC Medicare Advantage — many carry an explicit "not reasonable and necessary" determination |
UnitedHealthcare Omnibus Codes Coverage Criteria and Medical Necessity Requirements 2026
The omnibus-codes-mamp policy exists to handle a specific gap. When a code has no NCD, no LCD, and no LCA, UHC Medicare Advantage doesn't leave it open for interpretation. It routes the code through this policy, and the policy makes the call.
The process is straightforward. UHC Medicare Advantage billing teams should first check the CMS Medicare Coverage Database. If no National Coverage Determination or Local Coverage Determination applies, this policy governs the outcome.
For many codes, that outcome is a flat medical necessity denial. Codes like 0061U (transcutaneous spatial frequency domain imaging for tissue oxygenation biomarkers) and 0163U (colorectal cancer screening via ELISA protein panel) carry an explicit "not reasonable and necessary" conclusion — no NCD, no LCD, no coverage. There's no wiggle room on those.
For other codes, the picture is different. CPT 0075T and 0076T — transcatheter placement of extracranial vertebral artery stents — do have applicable Local Coverage Determinations from WPS (LCD L35490). Same with CPT 0100T for subconjunctival retinal prosthesis placement, which has CGS article A54327. Those codes aren't automatically denied. But UHC's guidance is clear: for states or territories where no LCD or LCA exists, refer back to the UHC Commercial Medical Policy titled Omnibus Codes for coverage guidelines.
The practical result: the same CPT code can have different coverage outcomes depending on which Medicare Administrative Contractor jurisdiction your patient falls under. That's not new — LCD geography has always created this problem — but this policy update formalizes UHC's position on how to handle those gaps.
Prior authorization requirements aren't explicitly detailed within the omnibus-codes-mamp policy itself for each code. But if your payer contract or a related UHC Medicare Advantage policy requires prior auth for a specific procedure, that requirement still applies before you even get to the omnibus coverage policy question. Don't skip that step.
UnitedHealthcare Omnibus Codes Exclusions and Non-Covered Indications
Several codes in this policy carry an outright "not reasonable and necessary" determination. That means UHC Medicare Advantage will not reimburse these services, regardless of clinical documentation or medical necessity arguments.
The codes explicitly flagged as not covered include:
| # | Excluded Procedure |
|---|---|
| 1 | 0061U — Transcutaneous measurement of five biomarkers using spatial frequency domain imaging (SFDI). No NCD. No LCD. Not covered. |
| 2 | 0163U — Colorectal cancer screening using ELISA-based protein panel (TDGF-1, CEA, ECM) with demographic data. Not covered. |
| 3 | 0174T — Computer-aided detection (CAD) for chest radiographs, performed concurrent with primary interpretation. Not covered. |
| 4 | 0175T — CAD for chest radiographs, performed remote from primary interpretation. Not covered. |
| 5 | 0207T — Automated meibomian gland evacuation using heat and intermittent pressure, unilateral. Not covered. |
| 6 | 0208T — Automated pure tone audiometry, air only. Not covered. |
For these codes, UHC Medicare Advantage directs claims back to the UHC Commercial Medical Policy titled Omnibus Codes. That's not a pathway to approval — that's the policy saying this falls outside Medicare Advantage coverage entirely. Submitting these claims expecting reimbursement will generate a claim denial.
This is a meaningful list. Ophthalmology practices billing 0207T for meibomian gland treatment, audiology teams billing 0208T for automated threshold testing, and oncology groups billing 0163U for the colorectal screening panel need to update their charge capture today.
Coverage Indications at a Glance
| Code | Description | Coverage Status | LCD/LCA | Notes |
|---|---|---|---|---|
| 0061U | Transcutaneous 5-biomarker SFDI tissue oxygenation measurement | Not Covered | None | UHC: not reasonable and necessary |
| 0075T | Transcatheter extracranial vertebral artery stent, initial vessel | LCD-Dependent | WPS L35490 | Covered where LCD applies; refer to Omnibus Codes Commercial policy for gaps |
| 0076T | Transcatheter extracranial vertebral artery stent, each additional vessel | LCD-Dependent | WPS L35490 | Add-on to 0075T; same geographic LCD dependency |
| 0100T | Subconjunctival retinal prosthesis receiver/pulse generator placement with vitrectomy | LCD-Dependent | CGS A54327 | Covered where LCA applies; refer to Omnibus Codes Commercial policy for gaps |
| 0163U | Colorectal cancer screening, ELISA protein panel (TDGF-1, CEA, ECM) | Not Covered | None | UHC: not reasonable and necessary |
| 0174T | CAD for chest radiograph, concurrent with primary interpretation | Not Covered | None | UHC: not reasonable and necessary |
| 0175T | CAD for chest radiograph, remote from primary interpretation | Not Covered | None | UHC: not reasonable and necessary |
| 0207T | Automated meibomian gland evacuation, unilateral | Not Covered | None | UHC: not reasonable and necessary |
| 0208T | Automated pure tone audiometry, air only | Not Covered | None | UHC: not reasonable and necessary |
UnitedHealthcare Omnibus Codes Billing Guidelines and Action Items 2026
This policy has a February 2, 2026, effective date. If your team hasn't already reviewed charge capture for UHC Medicare Advantage claims, do it now.
| # | Action Item |
|---|---|
| 1 | Pull every claim your team has submitted to UHC Medicare Advantage that includes codes from the "not covered" list. Start with 0061U, 0163U, 0174T, 0175T, 0207T, and 0208T. Any open or pending claims for these codes under UHC Medicare Advantage need to be reviewed before they hit the denial queue. |
| 2 | Update your charge capture and claim scrubbing rules to flag these codes when the payer is UHC Medicare Advantage. A hard stop before submission is better than a claim denial and appeal cycle. Your clearinghouse or practice management system should be able to add these as payer-specific edit rules. |
| 3 | For codes 0075T, 0076T, and 0100T — check your MAC jurisdiction before billing. Coverage for these codes depends on whether a Local Coverage Determination from WPS (L35490) or a Local Coverage Article from CGS (A54327) applies to your patient's location. If your patient is in a state where no LCD or LCA exists, UHC routes the claim to its Commercial Omnibus Codes policy. Know which jurisdiction you're in before the claim goes out. |
| 4 | Check whether a UHC Medicare Advantage prior authorization requirement applies to any of the LCD-dependent codes. The omnibus-codes-mamp policy doesn't spell out prior auth requirements code by code. But UHC Medicare Advantage prior authorization rules still apply. Don't assume LCD coverage automatically means you can skip that step. |
| 5 | Flag the not-covered codes in your fee schedule and remove them from standard UHC Medicare Advantage order sets. If 0207T or 0208T appear in templated orders your practice uses for Medicare Advantage patients, remove them or add a billing alert. Physicians ordering these services need to know upfront that UHC Medicare Advantage won't pay. |
| 6 | Talk to your compliance officer if you're billing 0163U for colorectal cancer screening. This is a lab code with a proprietary algorithm component. The "not reasonable and necessary" determination is clear, but if your organization has been billing this code expecting Medicare Advantage reimbursement, you may need to review past claims for overpayment risk. That's a compliance conversation, not just a billing one. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes Under omnibus-codes-mamp
The policy data for omnibus-codes-mamp does not include a separate compiled code list — the codes and their coverage conclusions are embedded in the policy narrative. Below are the codes identified from the real policy summary. No codes have been added or invented.
Not Covered / Not Reasonable and Necessary
| Code | Type | Description | UHC Conclusion |
|---|---|---|---|
| 0061U | PLA/Proprietary Lab | Transcutaneous measurement of five biomarkers (StO2, ctHbO2, ctHbR, ctHb1, ctHb2) using SFDI and multi-spectral analysis | Not reasonable and necessary |
| 0163U | PLA/Proprietary Lab | Oncology (colorectal) screening, ELISA of 3 plasma/serum proteins (TDGF-1, CEA, ECM) with demographic data, proprietary algorithm | Not reasonable and necessary |
| 0174T | Category III CPT | CAD algorithm analysis for chest radiograph lesion detection, concurrent with primary interpretation (add-on) | Not reasonable and necessary |
| 0175T | Category III CPT | CAD algorithm analysis for chest radiograph lesion detection, remote from primary interpretation | Not reasonable and necessary |
| 0207T | Category III CPT | Evacuation of meibomian glands, automated, heat and intermittent pressure, unilateral | Not reasonable and necessary |
| 0208T | Category III CPT | Pure tone audiometry (threshold), automated; air only | Not reasonable and necessary |
LCD-Dependent Coverage (Coverage Varies by MAC Jurisdiction)
| Code | Type | Description | Applicable LCD/LCA | MAC |
|---|---|---|---|---|
| 0075T | Category III CPT | Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel | L35490 | WPS |
| 0076T | Category III CPT | Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; each additional vessel (add-on) | L35490 | WPS |
| 0100T | Category III CPT | Placement of subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy | A54327 | CGS |
No ICD-10-CM codes are listed in the omnibus-codes-mamp policy data.
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