UnitedHealthcare modified its radiologic diagnostic procedures coverage policy, effective March 2, 2026. Here's what billing teams need to know.
UnitedHealthcare's updated policy under code radiologic-diagnostic-procedures tightens medical necessity documentation requirements across a broad range of imaging services — from CT and MRA to PET scans (CPT 78811–78816) and nuclear medicine procedures (CPT 78012–78999). The policy now makes clear that diagnostic imaging for asymptomatic patients is not covered, and every claim must carry a documented sign, symptom, or patient complaint. If your team bills any of these 47 affected CPT codes under a UnitedHealthcare Medicare Advantage plan, you need to review your documentation workflows before claims start moving.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | UnitedHealthcare |
| Policy | Radiologic Diagnostic Procedures – Medicare Advantage Medical Policy |
| Policy Code | radiologic-diagnostic-procedures |
| Change Type | Modified |
| Effective Date | March 2, 2026 |
| Impact Level | High |
| Specialties Affected | Radiology, Nuclear Medicine, Cardiology, Oncology, Pulmonology |
| Key Action | Confirm every imaging claim has a specific documented symptom or complaint before billing |
UnitedHealthcare Radiologic Diagnostic Procedures Coverage Criteria and Medical Necessity Requirements 2026
The core rule in this coverage policy is blunt: no symptom, no coverage. For every diagnostic imaging service you bill, the clinical record must show the specific sign, symptom, or patient complaint that makes the service reasonable and necessary. "Routine" or "screening" doesn't cut it under this policy.
UnitedHealthcare bases its medical necessity standard on Medicare statute — specifically, Title XVIII of the Social Security Act, Section 1862(a)(1)(A). That section excludes services that are not reasonable and necessary for diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member. This isn't a UHC-invented standard. It's Medicare's own language, applied through the MA framework.
For CT scans, UHC follows NCD 220.1 (National Coverage Determination for Computed Tomography). In regions without applicable LCDs or LCAs, and for plans outside the UnitedHealthcare Radiology Prior Authorization and Notification Program, the policy defers to InterQual CP: Imaging criteria. That's the standard used to judge whether a CT scan claim is reasonable and necessary when no MAC-level guidance applies.
For cardiac computed tomography (CCT) and coronary computed tomography angiography (CCTA) — also called multi-detector computed cardiac tomography (MDCT) — there is no NCD. CMS hasn't issued a national coverage determination for these services. Coverage depends entirely on whether a local coverage determination (LCD) or local coverage article (LCA) exists for your region. If none does, InterQual criteria apply.
Prior authorization requirements vary by plan. For members in plans where a delegate manages utilization management, that delegate's prior authorization rules control — not UHC's standard requirements. Know which plan type you're billing before you submit. If you're in a region covered by the UnitedHealthcare Radiology Prior Authorization and Notification Program, refer to the Medicare Advantage Plans Radiology and Cardiology Clinical Guidelines on UHCprovider.com.
For 3D rendering (CPT 76376 and 76377), applicable LCDs and LCAs exist and compliance is required where they apply. These aren't optional. Check the CMS Medicare Coverage Database for your region before billing these codes.
UnitedHealthcare Radiologic Diagnostic Procedures Exclusions and Non-Covered Indications
This policy does not cover screening radiology for asymptomatic patients when no CMS screening benefit exists. If a service has no defined CMS screening benefit and you bill it as a screening, UHC will deny it. That's not a gray area — the policy states it directly.
Certain ICD-10-CM diagnosis codes are explicitly excluded from coverage for MRA of the abdomen and pelvis. Z00.70, Z00.71, and Z00.8 are carved out of the non-coverage list for the following MRA CPT and HCPCS codes: 72198, 74185, C8900, C8901, C8902, C8918, C8919, and C8920. Read that carefully — these Z codes are excluded from non-coverage, meaning they can support coverage for those specific MRA codes. It's written in the negative, which creates room for confusion.
Note: The source policy data shows the final HCPCS code in this series as truncated ("C892"). The blog lists C8920 based on the expected code series, but verify the complete code against the actual policy document or applicable LCD/LCA before billing. If you're not sure, loop in your compliance officer before March 2, 2026.
If your billing team is uncertain how to apply that Z-code carve-out more broadly, talk to your compliance officer before the effective date. The double-negative structure is the kind of thing that gets misread under pressure.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Diagnostic imaging with documented symptom or complaint | Covered (when medically necessary) | All applicable CPT codes in policy | Specific sign/symptom required on every claim |
| CT scan per NCD 220.1 | Covered (when criteria met) | CT CPT codes | NCD 220.1 governs; InterQual used where no LCD/LCA exists |
| CCT / CCTA (no NCD) | Covered only where LCD/LCA applies | CCT/CCTA CPT codes | No national coverage determination; LCD/LCA or InterQual required |
| 3D Rendering | Covered where LCD/LCA criteria met | 76376, 76377 | LCD/LCA compliance required; check CMS database |
| PET imaging | Covered (when medically necessary) | 78608, 78811–78816 | Subject to NCD/LCD where applicable |
| Nuclear medicine — thyroid, parathyroid, adrenal | Covered (when medically necessary) | 78012–78099 | Medical necessity documentation required |
| Nuclear medicine — hepatobiliary, GI, musculoskeletal | Covered (when medically necessary) | 78226–78399 | InterQual criteria may apply in no-LCD regions |
| Nuclear medicine — pulmonary ventilation/perfusion | Covered (when medically necessary) | 78579–78599 | 78580, 78582, 78597, 78598 for V/Q imaging |
| SPECT — parathyroid and tumor localization | Covered (when medically necessary) | 78071, 78072, 78803 | SPECT-specific criteria apply |
| Diagnostic imaging for asymptomatic patients (no CMS screening benefit) | Not Covered | All codes | Billed as screening without CMS benefit — will be denied |
| MRA abdomen/pelvis billed with Z00.70, Z00.71, Z00.8 | Covered (carve-out from non-coverage) | 72198, 74185, C8900–C8902, C8918–C8920 | Z codes excluded from non-coverage list — verify full HCPCS code series against source policy before billing |
UnitedHealthcare Radiologic Diagnostic Procedures Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for documented symptom linkage before March 2, 2026. Every imaging claim needs a specific ICD-10-CM code tied to a documented sign, symptom, or complaint. Vague or unspecified codes won't satisfy medical necessity under this policy. If your charge capture process doesn't already enforce this, fix it now. |
| 2 | Check your region for applicable LCDs and LCAs before billing CT, CCT/CCTA, and 3D rendering codes. Go to the CMS Medicare Coverage Database. Your MAC may have issued an LCD that controls coverage. For CCT and CCTA specifically, an LCD may be the only path to reimbursement — there is no NCD. |
| 3 | Confirm prior authorization requirements for your specific plan type. Plans with delegate-managed utilization management follow the delegate's prior auth rules, not UHC's standard program. For plans in the UHC Radiology Prior Authorization and Notification Program, follow the Medicare Advantage Plans Radiology and Cardiology Clinical Guidelines. Don't assume all UHC MA plans work the same way. |
| 4 | Train your billing team on the Z-code carve-out for MRA claims. Z00.70, Z00.71, and Z00.8 are excluded from the non-coverage list for CPT 72198, 74185, and HCPCS C8900, C8901, C8902, C8918, C8919, and C8920. These codes can support MRA coverage. Verify the complete HCPCS code series against the source policy before billing — the policy data shows the final code as truncated. Make sure your team knows this before a claim denial triggers an unnecessary appeal. |
| 5 | Apply InterQual CP: Imaging criteria for claims in regions with no LCD or LCA. For CT scans and other imaging in states or territories without applicable LCDs, UHC uses InterQual to determine medical necessity. If your team isn't familiar with the current InterQual criteria, access them through the UHC provider portal. An undocumented gap here will show up as a claim denial. |
| 6 | Review unlisted procedure codes carefully. This policy includes several unlisted nuclear medicine codes — 78099, 78199, 78299, 78399, 78499, 78599, 78699, 78799, and 78999. Unlisted codes carry extra documentation burden. Each one requires supporting documentation that explains why a specific code couldn't be used. A bare unlisted code billed to UHC MA without clinical support is a denial waiting to happen. |
| 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 for Radiologic Diagnostic Procedures Under radiologic-diagnostic-procedures
Other Nuclear Medicine — Covered CPT Codes (When Medical Necessity Is Met)
| Code | Type | Description |
|---|---|---|
| 78012 | CPT | Thyroid uptake, single or multiple quantitative measurement(s) |
| 78013 | CPT | Thyroid imaging (including vascular flow, when performed) |
| 78014 | CPT | Thyroid imaging with single or multiple uptake(s) quantitative measurement(s) |
| 78015 | CPT | Thyroid carcinoma metastases imaging; limited area (e.g., neck and chest only) |
| 78016 | CPT | Thyroid carcinoma metastases imaging; with additional studies |
| 78018 | CPT | Thyroid carcinoma metastases imaging; whole body |
| 78070 | CPT | Parathyroid planar imaging (including subtraction, when performed) |
| 78075 | CPT | Adrenal imaging, cortex and/or medulla |
| 78099 | CPT | Unlisted endocrine procedure, diagnostic nuclear medicine |
| 78199 | CPT | Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine |
| 78226 | CPT | Hepatobiliary system imaging, including gallbladder when present |
| 78227 | CPT | Hepatobiliary system imaging with pharmacologic intervention |
| 78299 | CPT | Unlisted gastrointestinal procedure, diagnostic nuclear medicine |
| 78399 | CPT | Unlisted musculoskeletal procedure, diagnostic nuclear medicine |
| 78499 | CPT | Unlisted cardiovascular procedure, diagnostic nuclear medicine |
| 78579 | CPT | Pulmonary ventilation imaging (e.g., aerosol or gas) |
| 78580 | CPT | Pulmonary perfusion imaging (e.g., particulate) |
| 78582 | CPT | Pulmonary ventilation and perfusion imaging |
| 78597 | CPT | Quantitative differential pulmonary perfusion, including imaging when performed |
| 78598 | CPT | Quantitative differential pulmonary perfusion and ventilation, including imaging when performed |
| 78599 | CPT | Unlisted respiratory procedure, diagnostic nuclear medicine |
| 78699 | CPT | Unlisted nervous system procedure, diagnostic nuclear medicine |
| 78799 | CPT | Unlisted genitourinary procedure, diagnostic nuclear medicine |
| 78800 | CPT | Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical |
| 78801 | CPT | Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical |
| 78802 | CPT | Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical |
| 78804 | CPT | Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical |
| 78830 | CPT | Radiopharmaceutical localization of tumor/inflammatory process with SPECT |
| 78831 | CPT | Radiopharmaceutical localization of tumor/inflammatory process with SPECT |
| 78832 | CPT | Radiopharmaceutical localization of tumor/inflammatory process with SPECT |
| 78999 | CPT | Unlisted miscellaneous procedure, diagnostic nuclear medicine |
Note: CPT codes 78830, 78831, and 78832 appear in the "Other Nuclear Medicine" group per the source policy. They are not part of the SPECT group, which covers only 78071, 78072, and 78803.
Positron Emission Tomography (PET) — Covered CPT Codes (When Medical Necessity Is Met)
| Code | Type | Description |
|---|---|---|
| 78608 | CPT | Brain imaging, positron emission tomography (PET); metabolic evaluation |
| 78811 | CPT | PET imaging; limited area (e.g., chest, head/neck) |
| 78812 | CPT | PET imaging; skull base to mid-thigh |
| 78813 | CPT | PET imaging; whole body |
| 78814 | CPT | PET with concurrently acquired CT for attenuation correction and anatomy localization |
| 78815 | CPT | PET with concurrently acquired CT for attenuation correction and anatomy localization |
| 78816 | CPT | PET with concurrently acquired CT for attenuation correction and anatomy localization |
Single Photon Emission Computed Tomography (SPECT)
| Code | Type | Description |
|---|---|---|
| 78071 | CPT | Parathyroid planar imaging with tomographic (SPECT) |
| 78072 | CPT | Parathyroid planar imaging with tomographic (SPECT) and concurrently acquired CT |
| 78803 | CPT | Radiopharmaceutical localization; tomographic (SPECT) |
3D Rendering
| Code | Type | Description |
|---|---|---|
| 76376 | CPT | 3D rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality (not requiring independent workstation) |
| 76377 | CPT | 3D rendering with interpretation and reporting of CT, MRI, ultrasound, or other tomographic modality (requiring independent workstation) |
Key ICD-10-CM Diagnosis Code Coding Clarification
| Code | Notes |
|---|---|
| Z00.70 | Excluded from non-coverage for MRA CPT/HCPCS codes 72198, 74185, C8900, C8901, C8902, C8918, C8919, C8920 — verify complete HCPCS code series against source policy |
| Z00.71 | Excluded from non-coverage for the same MRA codes above |
| Z00.8 | Excluded from non-coverage for the same MRA codes above |
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