Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility

HLA testing performed for transplant histocompatibility is not separately payable by Medicare and must be billed as part of organ or allogeneic stem cell acquisition services by approved transplant centers (solid‑organ acquisition costs are paid on a reasonable cost basis; allogeneic stem cell acquisition costs are included in MS‑DRG/OPPS APC payments). HLA testing CPT codes used for non‑transplant indications may be covered under separate Local Coverage Determinations (e.g., CPT 81381 under L38294 and CPT 81383 under L36464) and must follow those LCD documentation rules.

"HLA testing performed as part of solid-organ transplant acquisition services (kidney, heart, lung, heart/lung, liver, pancreas, pancreas/kidney, intestinal/multi‑visceral) is covered when billed by..."

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