Skip to Main Content

Print | Bookmark | Font Size: + |

March 26, 2014Revised: April 10, 2015

AlloMap: Coding and Claim Submission Guidelines

Effective for services performed on or after 11/3/2014, coverage requirements for this test is addressed in CGS's Local Coverage Determination (LCD) for Molecular Diagnostic Tests (L35394).

The instructions in this article apply to services provided before 11/03/2014.

AlloMap, an In Vitro Diagnostic Multivariate Index assay (IVDMIA) test service performed in a single laboratory, is FDA-approved to aid in the identification of heart transplant recipients with stable allograft function who have a low probability of moderate/severe acute cellular rejection (ACR) at the time of testing in conjunction with standard clinical assessment.

Claims for AlloMap must include:

  • CPT code 86849 - Unlisted immunology procedure (NOC)
  • The appropriate ICD-9-CM code:
    • 996.83 Complications of transplanted heart
    • V42.1 Heart replaced by transplant
  • The name of the test (AlloMap):
    • Electronic claims: Loop 2400, NTE02, or SV101-7 field
    • Paper claims: in Block 19

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved