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

This billing and coding policy permits specified MolDX‑assessed molecular tests for assessing solid organ allograft rejection (kidney, heart, lung) when used for the indicated for‑cause or surveillance purposes and when billed in compliance with MolDX/Z‑code and timing requirements. Claims must report one unit of service (UOS=1), include the appropriate DEX Z‑Code and ICD‑10‑CM code in the prescribed claim fields, use distinct Z‑codes to denote for‑cause vs surveillance (and surveillance year 1 vs subsequent), and adhere to timing constraints (e.g., dd‑cfDNA tests ≥14 days post‑transplant; AlloMap ≥55 days; Prospera lung ≥28 days; VitaGraft ≥12 days).

"AlloMap (CareDx) is covered for heart surveillance testing performed at least 55 days (≥55 days) post-transplantation."

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