Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility

Medicare treats HLA testing for transplant histocompatibility as part of organ or allogeneic stem cell acquisition services and will not pay separately for CPT codes describing such HLA testing when billed as standalone laboratory services. Acquisition-related HLA testing by approved transplant centers is included in reasonable-cost reimbursement for solid organs or within MS-DRG/OPPS APC payments for allogeneic stem cell transplants, while autologous transplants do not carry acquisition charges. HLA testing unrelated to transplant is governed by other LCDs (e.g., CPT 81381 and 81383) with their own coverage rules.

"Medicare covers solid organ transplants including kidney, heart, lung, heart/lung, liver, pancreas, pancreas/kidney, and intestinal/multi-visceral transplants."

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