Laboratory Testing for Transplantation Rejection - (0465)

AlloMap (CPT 81595) is covered as medically necessary for heart transplant recipients age ≥15 who are 2 months (≥55 days) to 5 years post‑transplant when performed in lieu of routine endomyocardial biopsy for clinically low‑risk, stable grafts — documentation must show use instead of routine biopsy and intended to guide need for subsequent biopsy, age/timing, stable allograft function (no CHF signs, LVEF ≥45%, no severe CAV), low probability of moderate/severe rejection (no prior treated cellular or antibody‑mediated rejection), no prior AlloMap/biopsy discordance, and compliance with timing exclusions (e.g., ≥30 days since transfusion, ≥21 days since high‑dose steroids, 60 days after treated rejection). All other gene expression tests, donor‑derived cell‑free DNA assays, combined GEP+dd‑cfDNA tests, uses outside the above criteria, and AlloMap use in unvalidated groups (pregnancy, recent transfusion, recent high‑dose steroids or recent/treated rejection, prednisone ≥20 mg/day, AMR/hemodynamic compromise) are considered experimental, investigational, or not medically necessary.