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Transplant Immune Cell Function Assays (CPB 0773, reviewed 2026-10-28)
Effective date
Not stated in the notice
Identified
Oct 29, 2026
Summary
Aetna's CPB 0773 establishes coverage criteria for transplant immune cell function assays, covering only the ImmuKnow Assay (CPT 86352) for adjudicating over-immunosuppression in transplant recipients with co-morbid infection or cancer. All other immune cell function assays and most other indications of the ImmuKnow Assay are classified as experimental, investigational, or unproven and are not covered. Billing teams must verify medical necessity criteria before submitting claims to avoid denials.
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What to do
Action · 6 steps
01Billing team should review the ImmuKnow Assay coverage criteria in CPB 0773 and implement the following controls.
02For CPT 86352 claims, verify that the diagnosis supports one of the two covered indications (over-immunosuppression adjudication in transplant recipients with co-morbid infection OR cancer) using ICD-10 codes A00.0–B99.9 (infectious/parasitic diseases) or C00.0–D09.9 (malignant neoplasms, excluding renal cell carcinoma).
03Deny or refer for medical review any claims for CPT 86352 that do not meet these criteria or list excluded diagnoses (e.g., CMV risk stratification, organ rejection management, IBD management).
04Reject all claims for alternative tests including CPT 0118U, 0581U, 81560, T-SPOT.CMV, T-Track CMV, QuantiFERON-CMV, Pleximmune, or gamma interferon response assays, as these are non-covered.
05Ensure precertification/prior authorization processes in the billing system enforce these limitations.
06Update denial reason codes and communicate coverage limits to all in-network transplant centers and immunology practices to reduce claim rework and appeals.
Codes mentioned
863523824081560
Original notice
Transplant Immune Cell Function Assays (CPB 0773, reviewed 2026-10-28)
aetna.com · Always check the source before changing claims.
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