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

This billing and coding guidance requires that molecular tests for solid organ allograft rejection listed in the policy are covered only when they meet the clinical coverage criteria of LCD L38671 and are identifiable on the DEX registry. Claims must include the appropriate CPT code with 1 unit of service, the correct DEX Z-Code identifier adjacent to the CPT in the specified claim fields for Part A/B, and an appropriate ICD-10-CM diagnosis code; incorrect Z-codes, missing DEX registration, or failure to meet L38671 criteria may lead to denial.

"Any molecular test listed in this policy (AlloMap, AlloSure, HeartCare, Prospera, QSant, Tutivia, TruGraf, Viracor TRAC, VitaGraft) is covered when it meets the clinical coverage criteria of LCD L3..."

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