Billing and Coding: MolDX: MammaPrint

MammaPrint is covered when performed on FFPE breast cancer tissue to assess risk of distant metastasis in early-stage breast cancer. Only one assay (NGS or microarray) may be billed per patient per date of service; up to two lifetime tests may be allowed for bilateral disease with additional occurrences requiring appeal. Billing requires entry of '1' in Days/Unit, inclusion of the appropriate DEX Z‑Code adjacent to the CPT code in specified claim fields, and for NGS-performed tests using dates of service on/after 2022-01-01, use CPT 81523.

"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."

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