Billing and Coding: MolDX: MammaPrint®

MammaPrint® is a gene-expression diagnostic test performed on FFPE breast cancer tissue to assess risk of distant metastasis and may be run as either an FDA-cleared microarray assay or an NGS-based assay. Billing requires specific claim data (enter '1' in Days/Unit, include the appropriate DEX Z-Code adjacent to the CPT code, use SV101-7 or SV202-7/NTE fields, and select appropriate ICD-10-CM codes); only one assay type may be billed per date of service, and testing is generally limited to up to two lifetime occurrences for bilateral disease with additional tests requiring appeal and supporting documentation.

"MammaPrint® is indicated to analyze gene expression of FFPE breast cancer tissue to assess a patient's risk for distant metastasis (early-stage breast cancer)."

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