Billing and Coding: MolDX: MammaPrint

MammaPrint is a gene-expression diagnostic performed on FFPE breast tumor tissue to assess risk of distant metastasis and may be run using either the FDA-cleared microarray or an NGS-based assay. Billing requires specific claim entries (enter '1' in Days/Unit, submit DEX Z-Code adjacent to the CPT code, use SV101-7/SV202-7/NTE fields as specified), use CPT 81523 for NGS tests on/after 1/1/2022, and only one assay may be performed per patient per date of service; up to two lifetime tests may be allowed for bilateral disease with additional occurrences requiring appeal and supporting documentation.

"MammaPrint is used to analyze gene expression of FFPE breast cancer tumor tissue to assess a patient's risk of distant metastasis."

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