Billing and Coding: Prospera

This coverage article has been created and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV).

Effective Date: May 15, 2020
Summary of Article: Coverage of Prospera™ will continue on a case-by-case basis utilizing the following criteria until such time a more comprehensive non-proprietary Local Coverage Determination can be developed.

Prospera™ Assay will be covered only when the following clinical conditions are met:

  • When Prospera™ is utilized to supplement the evaluation and management of kidney injury and active rejection (AR) in patients who have undergone renal transplantation wherein the results will inform decision making supplementing standard clinical assessments and intervention in:
    • First time renal allograft recipients, and
    • Physician-assessed pretest need to further evaluate patient for the probability of active renal allograft rejection.

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Last Updated May 21, 2020