Laboratory tests for organ transplant rejection are used to screen for, estimate risk for, detect, or rule out rejection after organ transplantation. Peripheral blood gene expression profiling, such as AlloMap, may be considered medically necessary in heart transplant recipients who are at least 15 years old, at least 2 months post heart transplant, have no documented signs or symptoms of heart transplant rejection, and have no history of treatment for heart transplant rejection. Gene expression profiling for patients outside those criteria or for organs other than the heart is investigational, as are volatile organic compound breath tests for heart rejection, donor-derived cell-free DNA tests, simultaneous donor-derived cell-free DNA and gene expression testing, recipient lymphocyte response tests in cell culture for renal, liver, and small bowel transplants, gene expression profiling on biopsy tissue, urinary CXCL10 testing after renal transplant, and serum non-HLA autoantibody tests.
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01Already effective October 1, 2026: Billing team should submit for review, for heart transplant gene expression profiling, the name of the test, the relevant billing codes, and the related medical records, including the history and physical exam and the date of heart transplant.
02Clinical documentation must support that the patient is at least 15 years old, at least 2 months post heart transplant, has no documented signs or symptoms of heart transplant rejection, and has no history of treatment for heart transplant rejection.
03If any required item is not submitted, it could impact the review and decision outcome, and gene expression profiling for patients who do not meet these criteria is considered investigational.
04Providers are encouraged to tell members before rendering investigational or cosmetic services that members are likely to be financially responsible for the cost.
Codes mentioned
8147981558815608159586849
Original notice
Laboratory Tests for Organ Transplant Rejection
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