Does 81519 require prior authorization?

Yes, 81519 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 81519?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Bill the Oncotype DX Breast service using CPT code 81519.
Enter '1' in the Days/Unit field on the claim.
Select and include the appropriate ICD-10-CM diagnosis code on the claim (specific codes not listed in this policy).
Include the DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for Part B claims: Loop 2400 or SV101-7 for 837P electronic claims, and Box 19 for paper claims.

Oncotype DX Breast is indicated for estrogen-receptor (ER) positive, node-negative invasive carcinoma of the breast.
Oncotype DX Breast is indicated for estrogen-receptor (ER) positive micrometastases of carcinoma of the breast.
Oncotype DX Breast is indicated for estrogen-receptor (ER) positive breast carcinoma with 1–3 positive lymph nodes.
Oncotype DX Breast is indicated for estrogen-receptor–positive (ER+) invasive carcinoma of the breast that is lymph node–negative.
Oncotype DX Breast is indicated for estrogen-receptor–positive (ER+) breast carcinoma with micrometastases to regional lymph nodes.
Oncotype DX Breast is indicated for estrogen-receptor–positive (ER+) breast carcinoma with 1–3 pathologically positive regional lymph nodes.

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A55230 — Billing and Coding: MolDX: Oncotype DX Breast Cancer Assay

J05

A57772 — Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

J05

A59926 — Billing and Coding: Molecular Pathology Procedures

J06

L35000

Ask Verity about documentation requirements, denial risks, or coverage in your state.