Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - MEDICAID - SOUTH CAROLINA

This policy addresses molecular diagnostic assays (eg, gene‑expression panels, donor‑derived cell‑free DNA, CD154+ T‑cell assays, RBC antigen genotyping) and breath testing (BMAC/Heartsbreath) used to detect, monitor, or assess risk of allograft rejection in transplant recipients (heart, kidney, liver, small bowel, including pediatric indications). Major limitations/requirements: these noninvasive tests are described as adjuncts to — not replacements for — biopsy (the gold standard); specific uses have timing constraints (eg, Heartsbreath for grade 3 heart rejection within 1 year post‑transplant and may require a recent biopsy), and many assays are proprietary or noted as “purported” with limited explicit coverage, validation, or exclusion criteria in the policy.

"Inferred: Use of molecular diagnostic assays and breath testing to detect or monitor transplant rejection in transplant recipients (inferred from title: 'Molecular Diagnostic Assays and Breath Test..."