Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection

This billing/coding guidance requires molecular allograft rejection tests to meet MolDx LCD L38568 coverage criteria and to be billed with the correct CPT code, one unit of service, and an appropriate ICD-10-CM diagnosis. Claims must include the DEX Z-Code identifier adjacent to the CPT code (to indicate protocol vs for-cause testing) in the specified electronic or paper claim fields; covered tests listed (e.g., AlloMap, AlloSure, Prospera, QSant, Tutivia, TruGraf, Viracor TRAC, VitaGraft) are allowed only when indications align with the LCD criteria.

"Molecular testing for solid organ allograft rejection is covered when the test and its clinical use meet the coverage criteria specified in MolDx LCD L38568 (and L38582 billing guidelines)."

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