Medicare AdvantageCoverageMedium impact
Laboratory Tests Post Transplant and for Heart Failure (Former Title: Laboratory Tests for Heart and Kidney Transplant Rejection)
Blue Cross Blue Shield of Rhode Island·RI · Cardiology, Nephrology·Physician / Facility
Effective date
Jun 1, 2021
We identified it
Jun 19, 2026
Summary
Effective June 1, 2021, AlloSure Heart and AlloSure Kidney tests now have medical necessity criteria for Medicare Advantage plans only, while remaining non-covered for commercial plans. The policy has been expanded to incorporate molecular testing for chronic heart failure and heart transplant monitoring.
Action Required
Billing team must verify coverage requirements for AlloSure Heart and AlloSure Kidney tests: obtain prior authorization and document medical necessity for Medicare Advantage members only. Update billing system to flag these tests for MA plans while continuing to deny for commercial patients. Review archived molecular testing policy requirements now incorporated into this updated policy.