88341
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.55
Facility
$94.19
Non-Facility
$94.19
Documentation Required
- Claims for ER, PR, or HER2 IHC must include the CPT code, the specimen identifier, and the unit of service (UOS) for each separately identifiable specimen.
- For morphometric analysis, the claim must specify the appropriate CPT (88360 for manual or 88361 for computer-assisted) and the corresponding UOS.
- Claims for IHC testing must include the appropriate CPT code(s) and units of service as specified by this policy.
- Providers must document medical necessity in the medical record and ensure billing aligns with whether services were submitted globally or split between professional and technical providers.
Key Coverage Criteria
- IHC testing for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu is covered for patients with primary invasive breast cancer.
- IHC testing for ER, PR, and HER2/neu is covered for patients with recurrent or metastatic breast cancer.
- Immunohistochemical (IHC) testing for estrogen receptor (ER) is covered for patients with primary invasive breast cancer.
- IHC testing for progesterone receptor (PR) is covered for patients with primary invasive breast cancer.
- IHC testing for HER2/neu is covered for patients with primary invasive breast cancer.
- IHC testing for ER, PR, and HER2 is covered for patients with recurrent or metastatic breast cancer.
20 Active Policies
A55136 — Billing and Coding: Lab: Immunohistochemistry (IHC) Indications for Breast Pathology
J05
A57733 — Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains
J05
L36805 — Lab: Special Histochemical Stains and Immunohistochemical Stains
J05
CGS-L35986 — Special Histochemical Stains and Immunohistochemical Stains
J18 MAC Part B
Related Codes
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