Billing and Coding: Biomarkers for Oncology

This billing and coding article provides coding requirements and claim documentation rules for oncology biomarker tests referenced in LCD L35396. Several named molecular assays (including ThyraMIR, ThyGeNEXT, Afirma, ThyroSeq, RosettaGX Reveal, and others) must be billed with specific CPT codes, claim narrative identifiers, and, for several tests, are limited to once-per-lifetime coverage; use CPT 81479 with narrative for biomarkers not represented by Tier 1 codes and bill multi-test panels on a single CPT to avoid stacking.

"Rosetta Cancer Origin Test (CPT 81479) is covered when conventional surgical pathology and/or imaging work-up is unable to identify a primary neoplastic site and an 'Initial Work-Up …' comment is s..."

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