CommercialAdministrativeMedium impact
06.02.29d, AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)
Independence Blue Cross·Cardiology, Cardiothoracic Surgery, Transplant Surgery·Pharmacy
We identified it
Jun 19, 2026
Summary
Independence Administrators has updated the AlloMap™ Molecular Expression Testing policy disclaimer to clarify that it only applies to members whose groups have NOT enrolled in the UM vendor program. Groups that have enrolled in the UM vendor program must refer to the eviCore Lab Management Program instead. This is a superseded policy (version 06.02.29d); the current active policy is 06.02.29g.
Action Required
IMMEDIATE: Billing team must verify member group enrollment status BEFORE authorizing or billing AlloMap™ testing (CPT 81595). If the member's group is enrolled in Independence Administrators' UM vendor program, DENY the request and direct providers to the eviCore Lab Management Program for coverage determinations instead. Update claim adjudication logic in billing system to check group UM vendor enrollment status. Do NOT use this policy for any group that has elected the UM vendor program at their renewal effective date. Ensure all staff processing AlloMap™ claims understands this routing requirement to prevent claim denials and improper authorizations.