Medicare AdvantagePrior AuthMedium impact
Laboratory Tests Post Transplant and for Heart Failure
Blue Cross Blue Shield of Rhode Island·RI · Cardiology, Nephrology, Pulmonology·Physician / Facility
Effective date
Jul 1, 2022
We identified it
Jun 19, 2026
Summary
Effective July 1, 2022, four specific laboratory tests (HeartCare, Prospera, Viracor TRAC dd-cfDNA, and AlloSure Lung) for post-transplant and heart failure patients will require prior authorization for Medicare Advantage plans and will be considered not medically necessary for commercial plans. AlloSure Lung will be completely non-covered for Medicare Advantage plans.
Action Required
By July 1, 2022: Billing team must update system to require prior authorization for HeartCare, Prospera, Viracor TRAC dd-cfDNA, and AlloSure Lung tests for Medicare Advantage patients. Mark these tests as not medically necessary for commercial plans and non-covered for AlloSure Lung on Medicare Advantage. Update encounter forms to alert providers. Claims will be denied without proper authorization or may be rejected for commercial plans.