March 26, 2014 – Revised: 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