Billing and Coding: MolDX: Oncotype DX® Breast Cancer Assay

Oncotype DX Breast testing (CPT 81519) is intended for ER-positive invasive breast cancer in patients who are node-negative, have nodal micrometastases, or have 1–3 positive regional lymph nodes. Billing requires CPT 81519 with Days/Unit=1, selection of the appropriate ICD-10-CM diagnosis code, and placement of the DEX Z‑Code identifier adjacent to the CPT code in the specified claim fields for Part A and Part B; Oncotype DX DCIS is a separate test and must not share the same Z-Code.

"Oncotype DX Breast is indicated for estrogen-receptor–positive (ER+) invasive carcinoma of the breast that is lymph node–negative."

Sign up to see full coverage criteria, indications, and limitations.