Does 81521 require prior authorization?

Yes, 81521 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 81521?

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

For NGS performed on or after 2022-01-01, bill using CPT code 81523 adjacent to the appropriate DEX Z‑Code identifier in the claim narrative.
Enter '1' in the Days/Unit field on the claim for MammaPrint services.
For CPT non‑NOC codes, submit the required information using SV101-7 or SV202-7 (preferred) or the NTE field.
For Part B electronic claims, place the DEX Z‑Code adjacent to the CPT code in Loop 2400 or SV101-7 for 837P; for Part B paper claims place the DEX Z‑Code in Box 19.

MammaPrint is indicated to analyze the gene expression profile of FFPE breast cancer tissue to assess a patient's risk for distant metastasis.
MammaPrint is validated for use in early‑stage breast cancer (MINDACT) and may be used for patients with early‑stage breast cancer to inform risk of distant metastasis.
MammaPrint is used to analyze gene expression of FFPE breast cancer tumor tissue to assess a patient's risk of distant metastasis.
The test may be performed using either the FDA-cleared microarray assay or an NGS-based assay shown to be technically equivalent.
MammaPrint is covered when performed on formalin-fixed, paraffin-embedded (FFPE) breast cancer tissue to assess a patient's risk for distant metastasis in early-stage breast cancer.
MammaPrint® is indicated to analyze gene expression of FFPE breast cancer tissue to assess a patient's risk for distant metastasis (early-stage breast cancer).

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A55175 — Billing and Coding: MolDX: MammaPrint

J05

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

J05

A59926 — Billing and Coding: Molecular Pathology Procedures

J06

L35000

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