Billing and Coding: MolDX: MammaPrint

MammaPrint is covered to assess risk of distant metastasis from FFPE breast cancer tissue, primarily validated for early-stage breast cancer, and may be performed using either an FDA-cleared microarray assay or an NGS-based assay. Billing requires submission of the appropriate DEX Z-code adjacent to the CPT code (use CPT 81523 for NGS on/after 2022-01-01), entering '1' in the Days/Unit field, and using designated claim fields (SV101-7/SV202-7/Loop 2400/Block 80/Item 19 as applicable). Only one test is allowed per date of service, with an expected maximum of two lifetime tests for bilateral disease; additional occurrences require supporting documentation and appeal.

"MammaPrint testing of formalin-fixed paraffin-embedded (FFPE) breast cancer tissue is used to assess a patient's risk for distant metastasis, and is indicated in early-stage breast cancer as valida..."