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CPT 0055U: myTAIHEART™ PCR Test for Heart Transplant Rejection

CPT code 0055U is a Proprietary Laboratory Analyses (PLA) code that identifies the myTAIHEART™ laboratory test by TAI Diagnostics, Inc., a PCR-based molecular assay used alongside clinical assessment to evaluate a heart transplant recipient’s risk of rejecting a donor heart. As a PLA code, 0055U applies specifically to this single manufacturer’s test, supporting clarity in billing and tracking of this proprietary diagnostic.

Nationally, the code matters because molecular assays for transplant rejection influence clinical decision-making, utilization of immunosuppression, and downstream resource use. Payors commonly discussing coverage and payment for such assays include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payors shape access through coverage policies, prior authorization requirements, and coding guidance.

Readers will learn how 0055U is defined clinically and operationally, which payors are relevant for national coverage discussions, and what to expect in terms of the test’s role in transplant care pathways. The publication provides benchmarks and policy context where available, explains typical service settings, and outlines the clinical intent and application of the assay. Data not available in the input will be noted as such in corresponding sections.

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Billing Code Overview

CPT code 0055U is a Proprietary Laboratory Analyses (PLA) code for the myTAIHEART™ laboratory test developed by TAI Diagnostics, Inc. The test uses PCR technology in conjunction with standard clinical assessment to help determine a heart transplant recipient’s likelihood of rejecting a donor heart.

Service Type: Proprietary laboratory molecular diagnostic test (PCR-based) for heart transplant rejection assessment

Typical Site of Service: Clinical laboratory or hospital outpatient laboratory

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CPT 0055U: myTAIHEART™ PCR Test for Heart Transplant Rejection

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Get alerted when payer policies referencing 0055U are released or updated.

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Billing Code Overview

Service Type: Proprietary laboratory molecular diagnostic test (PCR-based) for heart transplant rejection assessment

Typical Site of Service: Clinical laboratory or hospital outpatient laboratory

Clinical & Coding Specifications

Clinical Context

A 56-year-old heart transplant recipient presents for routine post-transplant surveillance. The patient is clinically stable but requires laboratory monitoring to detect early allograft rejection. The transplant cardiology team orders the 0055U myTAIHEART™ PCR-based assay performed by TAI Diagnostics, Inc., to assess the molecular signature associated with rejection risk. A peripheral whole-blood sample is collected in the outpatient transplant clinic or hospital laboratory, labeled with the patient and test identifiers, and shipped to the performing laboratory per the manufacturer's instructions. Results are returned to the transplant cardiologist and incorporated with clinical assessment, echocardiography, endomyocardial biopsy results (if available), immunosuppressive drug levels, and other laboratory data to inform surveillance and management decisions. Typical sites of service include outpatient transplant clinics, hospital inpatient units for post-operative monitoring, and specialty laboratory collection centers. Common patient clinical features prompting this test include routine surveillance after transplant, unexplained allograft dysfunction, or concern for rejection when noninvasive assessment is preferred or used adjunctively.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier applicable (placeholder)	Rarely used; default billing when no other modifier applies.
`11`	Primary or sole practitioner	When the billing provider is the primary practitioner responsible for the service.
`22`	Increased procedural services	If additional work beyond the typical test handling is required by the performing laboratory and documentation supports greater complexity.
`23`	Unusual anesthesia	Not typically applicable to this laboratory test; included for completeness when anesthesia-related services occur during specimen collection.
`26`	Professional component	When billing separates the professional (interpretive) component from the technical component; use if the performing physician bills for interpretation distinct from the laboratory technical component.
`52`	Reduced services	If the test was partially reduced or not completed as originally planned and documentation supports reduced service.
`53`	Discontinued procedure	If specimen collection or testing was started but discontinued for reasons documented in the medical record.
`62`	Two surgeons or primary providers	Rare for this test; use only if two qualified providers share primary responsibility for the service and payer allows.
`78`	Return to operating room	Not typically applicable; included when return to OR leads to additional testing related to transplant care.
`80`	Assistant surgeon	Not typically applicable to laboratory billing; included for rare scenarios where an assistant is involved in sample procurement during a surgical procedure.
`AD`	Advanced diagnostic laboratory	Use where payer requires identification of an advanced diagnostic laboratory service; depends on payer policy.
`TC`	Technical component	When billing only the technical component of the test (laboratory processing) and the performing lab bills separately from any professional interpretation.
`QK`	Medical direction of two or three assistants	Uncommon for this procedure; included for completeness when applicable.
`QX`	Modifier identifying certified surgical assistant	Not typical for laboratory testing; included for billing systems that accept it when an assistant role is billed.

Taxonomy Code	Specialty	Notes
207RP0221X	Transplant Cardiology	Physicians who order and interpret surveillance testing for heart transplant recipients.
207RC0000X	Cardiology	General cardiology involvement in post-transplant care and test ordering.
363L00000X	Clinical Laboratory	Laboratories performing the technical component of PCR-based proprietary tests.
207LP2900X	Cardiac Surgery	Cardiac surgeons involved in perioperative transplant care who may order surveillance testing.
2084P0800X	Clinical Pathology	Pathologists overseeing molecular assay interpretation and laboratory quality.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T86.2`	Heart transplant failure and rejection	Direct indication for use of `0055U` to evaluate risk or presence of allograft rejection.
`Z94.1`	Heart transplant status	Surveillance testing is performed routinely in patients with this status to monitor for rejection.
`I50.9`	Heart failure, unspecified	Worsening heart failure symptoms in a transplant recipient may prompt molecular rejection testing as part of evaluation.
`I97.121`	Postprocedural cardiac failure following cardiac transplant	Used when post-transplant dysfunction prompts molecular assays to assess rejection risk.
`R94.31`	Abnormal results of cardiac function studies	Abnormal noninvasive testing may trigger adjunctive molecular testing for rejection assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0034U`	Molecular assay for transplant rejection (example PLA)	Other proprietary molecular assays may be ordered for comparison or alternative platforms in transplant rejection surveillance; often part of differential laboratory strategies.
`83516`	Antibody; drug assay by immunoassay with drug confirmation	Therapeutic drug monitoring of immunosuppressants is commonly performed alongside molecular rejection testing to correlate drug levels with rejection risk.
`86336`	Antibody; immunoassay for infectious agents, qualitative or semiquantitative	Infectious disease testing is commonly performed in the post-transplant setting to evaluate causes of allograft dysfunction versus rejection.
`88305`	Surgical pathology, gross and microscopic examination	Endomyocardial biopsy pathology is a standard comparator for rejection assessment when biopsy is performed alongside molecular testing.
`99000`	Handling and/or conveyance of specimen	Billing for specimen collection/handling may be relevant when special handling or courier services are required to send samples to a proprietary laboratory.

CPT 0001U: PreciseType HEA Multiplex Erythrocyte Antigen Assay

CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

CPT 0002U: Urine Metabolomic Polyp Risk Assay (PolypDX™)

CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

CPT 0003U: Overa™ (OVA1 Next Generation) Ovarian Cancer Risk Assay

CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

CPT 0005U: ExosomeDx Prostate (IntelliScore) Urine Gene Expression Risk Test

CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

CPT 0007U: ToxProtect Urine Drug Screen with DNA Authentication

CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

CPT 0008U: H. pylori Antibiotic Resistance Panel, Gene Sequence Analysis

CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

CPT 0011U: Cordant CORE™ Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcript Testing

Showing 1–10 of 536

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier applicable (placeholder)	Rarely used; default billing when no other modifier applies.
`11`	Primary or sole practitioner	When the billing provider is the primary practitioner responsible for the service.
`22`	Increased procedural services	If additional work beyond the typical test handling is required by the performing laboratory and documentation supports greater complexity.
`23`	Unusual anesthesia	Not typically applicable to this laboratory test; included for completeness when anesthesia-related services occur during specimen collection.
`26`	Professional component	When billing separates the professional (interpretive) component from the technical component; use if the performing physician bills for interpretation distinct from the laboratory technical component.
`52`	Reduced services	If the test was partially reduced or not completed as originally planned and documentation supports reduced service.
`53`	Discontinued procedure	If specimen collection or testing was started but discontinued for reasons documented in the medical record.
`62`	Two surgeons or primary providers	Rare for this test; use only if two qualified providers share primary responsibility for the service and payer allows.
`78`	Return to operating room	Not typically applicable; included when return to OR leads to additional testing related to transplant care.
`80`	Assistant surgeon	Not typically applicable to laboratory billing; included for rare scenarios where an assistant is involved in sample procurement during a surgical procedure.
`AD`	Advanced diagnostic laboratory	Use where payer requires identification of an advanced diagnostic laboratory service; depends on payer policy.
`TC`	Technical component	When billing only the technical component of the test (laboratory processing) and the performing lab bills separately from any professional interpretation.
`QK`	Medical direction of two or three assistants	Uncommon for this procedure; included for completeness when applicable.
`QX`	Modifier identifying certified surgical assistant	Not typical for laboratory testing; included for billing systems that accept it when an assistant role is billed.

Taxonomy Code	Specialty	Notes
207RP0221X	Transplant Cardiology	Physicians who order and interpret surveillance testing for heart transplant recipients.
207RC0000X	Cardiology	General cardiology involvement in post-transplant care and test ordering.
363L00000X	Clinical Laboratory	Laboratories performing the technical component of PCR-based proprietary tests.
207LP2900X	Cardiac Surgery	Cardiac surgeons involved in perioperative transplant care who may order surveillance testing.
2084P0800X	Clinical Pathology	Pathologists overseeing molecular assay interpretation and laboratory quality.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T86.2`	Heart transplant failure and rejection	Direct indication for use of `0055U` to evaluate risk or presence of allograft rejection.
`Z94.1`	Heart transplant status	Surveillance testing is performed routinely in patients with this status to monitor for rejection.
`I50.9`	Heart failure, unspecified	Worsening heart failure symptoms in a transplant recipient may prompt molecular rejection testing as part of evaluation.
`I97.121`	Postprocedural cardiac failure following cardiac transplant	Used when post-transplant dysfunction prompts molecular assays to assess rejection risk.
`R94.31`	Abnormal results of cardiac function studies	Abnormal noninvasive testing may trigger adjunctive molecular testing for rejection assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0034U`	Molecular assay for transplant rejection (example PLA)	Other proprietary molecular assays may be ordered for comparison or alternative platforms in transplant rejection surveillance; often part of differential laboratory strategies.
`83516`	Antibody; drug assay by immunoassay with drug confirmation	Therapeutic drug monitoring of immunosuppressants is commonly performed alongside molecular rejection testing to correlate drug levels with rejection risk.
`86336`	Antibody; immunoassay for infectious agents, qualitative or semiquantitative	Infectious disease testing is commonly performed in the post-transplant setting to evaluate causes of allograft dysfunction versus rejection.
`88305`	Surgical pathology, gross and microscopic examination	Endomyocardial biopsy pathology is a standard comparator for rejection assessment when biopsy is performed alongside molecular testing.
`99000`	Handling and/or conveyance of specimen	Billing for specimen collection/handling may be relevant when special handling or courier services are required to send samples to a proprietary laboratory.

CPT 0001U: PreciseType HEA Multiplex Erythrocyte Antigen Assay

CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

CPT 0002U: Urine Metabolomic Polyp Risk Assay (PolypDX™)

CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

CPT 0003U: Overa™ (OVA1 Next Generation) Ovarian Cancer Risk Assay

CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

CPT 0005U: ExosomeDx Prostate (IntelliScore) Urine Gene Expression Risk Test

CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

CPT 0007U: ToxProtect Urine Drug Screen with DNA Authentication

CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

CPT 0008U: H. pylori Antibiotic Resistance Panel, Gene Sequence Analysis

CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

CPT 0011U: Cordant CORE™ Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcript Testing

Showing 1–10 of 536

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 0055U: myTAIHEART™ PCR Test for Heart Transplant Rejection

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Billing Code Overview

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CPT 0055U: myTAIHEART™ PCR Test for Heart Transplant Rejection

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References