Medicare AdvantageCoverageMedium impact
Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - Medicare Advantage (Revised)
Humana·Transplant Surgery, Cardiology, Nephrology +2 more·Medicare Advantage
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their policy for molecular diagnostic assays and breath testing for transplant rejection, effective December 1, 2025. This policy covers various gene expression tests, DNA/RNA assays, and breath testing procedures used to monitor organ transplant recipients for rejection without requiring invasive biopsies.
Action Required
Before December 1, 2025: Billing team should review current transplant rejection monitoring procedures and verify coverage criteria for molecular diagnostic tests and breath testing under Humana Medicare Advantage plans. Contact Humana to confirm specific prior authorization requirements and coverage limitations for these specialized tests. Update billing protocols to reference the appropriate Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs) based on practice location.