CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Human Leukocyte Antigen (HLA) Testing Mandate

State-mandated coverage rules for HLA testing for Blue Cross & Blue Shield of Rhode Island members, including required consent, accreditation, lifetime limit, and billing modifier guidance. Applies to Medicare Advantage and commercial products issued or renewed in Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyHuman Leukocyte Antigen (HLA) Testing Mandate

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 19, 1998

Next Review DateN/A

Key ActionObtain signed informed consent authorizing use of results for the National Marrow Donor Program and submit mandated HLA test claims with modifier 32.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1member test limit specified

86813,86817CPT codes listed

modifier 32Required billing modifier

A,B,DRAntigens required

Coverage Criteria

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Mandated HLA Testing Coverage Criteria

Covered per Rhode Island statute and BCBSRI policy for marrow donor program participation when the following requirements are met:

Mandated HLA testing coverage: Test is for HLA (A, B, DR) for utilization in bone marrow transplantation or participation in the National Marrow Donor Program

Statutory requirement per RIGL 27-20-36; service covered for BCBSRI members

Facility and consent requirements: Testing must be performed in a facility accredited by the American Association of Blood Banks (or successor) and licensed under applicable clinical laboratory regulations; a signed informed consent must authorize use of results for participation in the National Marrow Donor Program

See documentation and ordering requirements

Billing and lifetime limit: Submit claims for mandated HLA testing with modifier 32; members are limited to one mandated HLA test per lifetime1 per lifetime

Other medically necessary HLA testing uses are covered when appropriate and should be submitted without modifier 32

Covered Indications

HLA typing for A, B, and DR antigens

Indication: HLA typing for A, B, and DR antigens for use in bone marrow transplantation and participation in the National Marrow Donor Program

Additional uses: All other medically necessary uses of HLA testing are covered when appropriate

Submit without modifier 32 for non‑mandated medical uses

Frequency Limits

Mandated HLA test lifetime limit

Lifetime limitMembers are limited to one mandated HLA test per lifetime (1 per lifetime).

Applies toMedicare Advantage and commercial products delivered or renewed in Rhode Island.

Billing requirementClaims for the mandated HLA test must be submitted with modifier 32.

Program participationMember must participate in the National Marrow Donor Program for the mandated test.

Provider Actions & Requirements

Prior Authorization

Prior authorization is not required for HLA testing under this policy. However, coverage remains subject to the member's Evidence of Coverage (EOC) and the group contract terms.

Not required: prior authorization

Note

Documentation Required

Informed Consent & Facility Accreditation

A signed informed consent form must be completed at the time of testing. The consent must authorize use of test results for participation in the National Marrow Donor Program. Testing must be performed in a facility accredited by the American Association of Blood Banks (AABB) or its successor and meet applicable CLIA/licensing requirements.

Signed informed consent required at time of testing
Facility must be AABB-accredited and appropriately licensed (CLIA)

Denial Risk

Coverage May Vary by Group

Benefits and coverage may vary by group contract. Self-funded (ERISA) groups may choose whether to follow state mandates; if a group/EOC does not adopt the Rhode Island mandate, coverage may be denied per the member's contract.

Verify member EOC and group contract for coverage details
Self-funded groups may not be subject to state-mandated benefits

Ordering Requirements

Billing Rule

Ordering requirement — signed informed consent

At the time of ordering, obtain a signed informed consent that authorizes the test results to be used for participation in the National Marrow Donor Program and retain this documentation with the member's record.

Consent must be completed at time of testing and explicitly authorize use of results for the National Marrow Donor Program.
Ensure testing occurs in an AABB‑accredited and appropriately licensed facility; document accreditation/license as applicable.

Not Covered

NOT COVERED: The mandated HLA test required by Rhode Island statute may not be covered for members whose group or Evidence of Coverage does not adopt the state mandate (for example, some self‑funded employer groups). Providers should verify the member’s specific plan benefits and Evidence of Coverage prior to testing to avoid claim denials.

Background

BACKGROUND: Rhode Island law requires coverage of human leukocyte antigen (HLA) testing for the A, B, and DR antigens for use in bone marrow transplantation and for participation in the National Marrow Donor Program. However, actual payment for the mandated service depends on the member’s group contract and Evidence of Coverage; self‑funded groups may elect not to adopt the state mandate.

Definitions

HLA (Human leukocyte antigen) definition

TermHuman leukocyte antigen (HLA), also referred to as histocompatibility locus antigen for A, B, and DR antigens.

PurposeUsed for matching in bone marrow transplantation and for participation in the National Marrow Donor Program.

Antigens required by statuteA, B, and DR antigens must be included per Rhode Island law.

Facility and consentTesting must be performed in an AABB‑accredited and appropriately licensed facility; informed consent must authorize use of results for the National Marrow Donor Program.