Billing and Coding: Lab: Immunohistochemistry (IHC) Indications for Breast Pathology

ER, PR, and HER2/neu immunohistochemistry (IHC) testing is covered for patients with primary invasive breast cancer and for recurrent or metastatic breast cancer. Other biomarkers (e.g., Ki-67, PI3K, gene expression assays) are not supported due to lack of standardized value. Claims must include the correct CPT code, specimen identifier, and unit-of-service mapping (88342 UOS=1; 88341 UOS=2; 88360/88361 UOS=3), with units applied per separately identifiable specimen.

"IHC testing for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu is covered for patients with primary invasive breast cancer."

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