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