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

MolDX-covered molecular assays that have completed technical assessment and meet LCD DL40058 are covered for assessment of solid organ (kidney, heart, lung) allograft rejection for specified intended uses (for-cause and surveillance) when billed according to MolDX billing rules. Coverage is test- and use-specific with timing constraints for certain assays (e.g., AlloMap >=55 days, Prospera >=28 days, VitaGraft >=12 days, dd-cfDNA-only tests >=14 days), requires distinct DEX Z-codes for intended use, and only one molecular service (UOS=1) may be billed per patient encounter; molecular tests billed same day as biopsy will be auto-denied except in rare LCD-exempt cases.

"MolDX-technical-assessed molecular tests that are compliant with LCD DL40058 for assessing solid organ allograft rejection are covered when used for the indicated organ and intended use described b..."