Does 81519 require prior authorization?

No, 81519 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 81519?

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

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Use CPT code 81519 to bill the Oncotype DX Breast assay.
Enter '1' in the Days/Unit field on the claim.
Labs must submit required test information using SV101-7 or SV202-7 (SV202-7 preferred) or the NTE field.
For Part B electronic claims (5010A1 837P) enter the assigned DEX Z-Code Identifier in the comment/narrative (Loop 2400 or SV101-7).

Oncotype DX Breast is intended for patients with estrogen-receptor (ER) positive micrometastases of carcinoma of the breast.
Oncotype DX Breast is intended for patients with estrogen-receptor (ER) positive breast carcinoma with 1–3 positive lymph nodes.
Oncotype DX Breast is intended for patients with estrogen-receptor (ER) positive, node-negative invasive carcinoma of the breast.
When a molecular panel of 5–50 genes is ordered, bill the appropriate panel CPT code (81445, 81449, 81450, or 81451) instead of submitting individual single-gene CPT codes.
When 51 or more genes are ordered for molecular biomarkers, bill the appropriate large-panel CPT code (81455 or 81456) rather than individual gene codes.
When a panel contains more than one but fewer than five genes, use the corresponding existing panel CPT code or CPT 81479 (unlisted molecular pathology procedure) if no specific panel CPT exists.

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

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

J05

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

J05

L35000 — Molecular Pathology Procedures

J06

A59926

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