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IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.
Content provided on this page contains outdated information and instruction and should not be considered current. CGS is providing this archived information for research purposes only. This archived section contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

October 12, 2015 - 12.22.15

AlloMap Coding and Billing Guidelines (CM00023, V3)

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.

To bill for AlloMap services, please provide the following claim information:

  • For DOS prior to 01/01/2016 CPT code 81479 - Unlisted molecular pathology procedure (NOC)
  • For DOS 01/01/2016 and forward CPT code 81595 – Cardiology (heart transplant), mRNA gene profiling of 30 genes

Enter assigned Z-Code ID in the comment/narrative field for the following claim field/types:

  • Loop 2300 NTE 01 for Part A or Loop 2400 or SV101-7 field for part B
  • Submit Z-Code Identifier on an attachment to the claim form for paper claim (Form locator 80 for part A or Box 19 for part B)

Select the appropriate ICD-9-CM diagnosis from the following list:

  • 996.83 Complications of transplanted heart
  • V42.1 Heart replaced by transplant

ICD-10-CM codes:

  • Z48.21 – Encounter for aftercare following heart transplant
  • Z94.1 – Heart transplant status

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