Billing and Coding: MolDX: HLA Testing for Transplant Histocompatibility

HLA testing for transplant histocompatibility is not payable as a standalone laboratory service; it is covered only as part of organ acquisition services provided by approved transplant centers for Medicare-covered solid organ transplants and as a component of allogeneic stem cell transplant acquisition services included in MS-DRG or OPPS APC payments. Separate billing of HLA CPT codes for transplant histocompatibility will be denied; HLA testing for non-transplant indications may be covered under separate LCDs (e.g., L38435, L37003). Billing must follow CMS Pub 100-04 Chapter 3 Section 90 and 42 CFR Part 412 requirements.

"HLA testing for histocompatibility is covered when performed as part of solid organ acquisition services for Medicare-covered transplants (kidney, heart, lung, heart/lung, liver, pancreas, pancreas..."

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