CommercialCoverageMedium impact
Laboratory Testing for Transplantation Rejection 2.02.55
Excellus BlueCross BlueShield·Cardiology, Nephrology, Cardiothoracic Surgery·Lab Tests (pathology)
Effective date
Jul 17, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their laboratory testing policy for transplant rejection monitoring, establishing specific criteria for gene expression profiling (AlloMap) coverage in heart transplant patients while classifying several other newer tests as investigational and non-covered. The policy is effective July 17, 2025.
Action Required
By July 17, 2025: Billing team must update prior authorization requirements for transplant rejection laboratory testing. For Excellus BCBS members, ensure AlloMap (gene expression profiling) requests include documentation that patient is 15+ years old, 55 days to 5 years post-heart transplant, and meets all stability criteria (LVEF ≥45%, no heart failure symptoms, limited rejection history). Mark dd-cfDNA tests (AlloSure, Prospera, myTAIHEART), CD154+T-cytotoxic memory cell tests (Pleximark), and Molecular Microscope systems (MMDx-Heart, MMDx-Kidney) as investigational/non-covered for this payer. Update billing system rules to prevent automatic submission of these investigational tests.