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- CMS, MAC’s Proposed Change in Coverage for Organ Transplantation Rejection Test Not Finalized
On August 16, the CMS and Medicare Administrative Contractors (MACs) decided to not finalize the MolDx: Molecular Testing for Solid Organ Allograft Rejection proposed local coverage determination (LCD) issued on August 10, 2023. This is in response to public comments.
The CMS stated: “Due to the importance of identifying solid organ allograft rejection early and to ensure the public has additional opportunities to comment on the policy, the MACs intend to issue a new LCD in the coming months. When posted, the new proposed LCD will be available for review in the Medicare Coverage Database (MCD).”
At this time, the CMS or MACs have not changed coverage for these blood tests that monitor for organ transplantation rejection when ordered by their physicians in medically appropriate circumstances.
Patients with transplanted hearts, lungs, or kidneys who meet Medicare’s existing local coverage criteria can continue to access these blood tests, including under the following circumstances:
- When there are signs or symptoms of rejection.
- After a physician-assessed pretest, including for surveillance testing.
- After an indeterminate biopsy.
- As a replacement for a biopsy when deemed clinically appropriate by the patient’s qualified physician.
- For evaluation of the adequacy of immunosuppression.