Omnibus Codes – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare's Omnibus Codes policy (effective 05/01/2025) designates the vast majority of listed CPT/HCPCS/DME codes as "Unproven" and not medically necessary (excluded), while a limited set are "Covered in certain circumstances" or "Proven in certain circumstances" — for example, remote monitoring (CPT 93264) and replacement electronics (G0555) for implanted pulmonary artery pressure sensors and monitoring/removal of existing CardioMEMS devices are conditionally covered, and CPT 63268 and surgical treatment of sacral perineural (Tarlov) cysts are proven only when strict clinical/radiologic criteria are met (pain and neurologic deficits attributable to the cyst, radiologic correlation, and failure of ≥12 weeks non‑surgical therapy). The excerpt explicitly lists many excluded/unproven services (e.g., pulse‑echo ultrasound BMD, MBDA for RA, therapeutic drug monitoring of IBD biologics, retinal prostheses, robotic exoskeletons, automated/self‑administered audiometry, thermal pulsation for MGD, and numerous novel imaging/algorithmic tests) and provides no comprehensive prior‑authorization or documentation checklist beyond the limited clinical criteria noted for the few proven/covered items.