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Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - Medicare Advantage (Revised)

Humana·IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH, CA, HI, NV, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AR, CO, LA, MS, NM, OK, TX, DE, DC, MD, NJ, PA, AL, GA, TN, NC, SC, VA, WV, FL, PR · Transplant Surgery, Cardiology, Nephrology +1 more·Medicare Advantage
Effective date
Aug 30, 2026
We identified it
Aug 28, 2026
Days to comply
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Summary

Humana Medicare Advantage has updated its policy on molecular diagnostic assays and breath testing for transplant rejection, effective 08/30/2026. This policy establishes coverage criteria and references for gene expression profiling tests, antigen-specific T-cell function assays, breath testing (BMAC/Heartsbreath), and donor-derived cell-free DNA tests used to monitor organ transplant recipients. Billing teams must verify MAC-specific Local Coverage Determinations (LCDs) by geographic jurisdiction, as coverage and coding requirements vary significantly by region.

Action Required

Action needed
By 08/30/2026: Billing team must review the MAC-specific Local Coverage Determinations (LCDs) applicable to your geographic jurisdiction listed in the policy table (MACs: J5, J6, J8, J15, JE, JF, JH, JJ, JL, JN). For each regional LCD covering molecular diagnostic tests for transplant rejection (including MolDX policies L36807, L35000, L38582, L35160, L40060, L40062, L35025, L34519 and others), extract specific CPT/HCPCS codes and update billing system rules and prior authorization requirements accordingly. Verify current coverage status, coding requirements, and documentation needs with each MAC before submitting claims. Update provider education materials and encounter templates to reflect regional coverage variations. Contact each MAC's utilization management department to clarify coverage criteria for gene expression profiling, breath testing, and dd-cfDNA tests in your service area. Failure to follow MAC-specific requirements will result in claim denials and rework.

Related policy hubs

Humana policiesIA policy changesKS policy changesMO policy changesNE policy changesIN policy changesMI policy changesIL policy changesMN policy changesWI policy changesCT policy changesMA policy changesME policy changesNH policy changesNY policy changesRI policy changesVT policy changesKY policy changesOH policy changesCA policy changesHI policy changesNV policy changesAK policy changesAZ policy changesID policy changesMT policy changesND policy changesOR policy changesSD policy changesUT policy changesWA policy changesWY policy changesAR policy changesCO policy changesLA policy changesMS policy changesNM policy changesOK policy changesTX policy changesDE policy changesDC policy changesMD policy changesNJ policy changesPA policy changesAL policy changesGA policy changesTN policy changesNC policy changesSC policy changesVA policy changesWV policy changesFL policy changesPR policy changesTransplant SurgeryCardiologyNephrologyPulmonology