MedicaidCoverageMedium impact
Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Transplant Surgery, Cardiology, Nephrology·Medicaid
Effective date
Mar 9, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid in South Carolina now covers only specific AlloSure Heart and Kidney donor-derived cell-free DNA tests for transplant rejection monitoring with strict frequency limits. All other molecular diagnostic assays, breath testing, and gene expression tests for transplant rejection are not covered.
Action Required
Before March 9, 2026: Billing team must update prior authorization workflows to contact Corporate Transplant Department (1-866-421-5663 or transplant@humana.com) for all transplant rejection testing requests. Update billing system to limit AlloSure Heart (0540U) and Kidney (0544U) to specified frequencies and verify contraindications. Flag all other transplant rejection molecular tests as non-covered for South Carolina Medicaid members.