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

Oncotype DX Breast is covered for estrogen-receptor positive invasive breast carcinoma in node-negative patients, patients with micrometastases, and patients with 1–3 positive nodes. Billing requires CPT 81519, entry of '1' in Days/Unit, submission of the assigned DEX Z-Code Identifier in specified claim fields (SV101-7, SV202-7, Loop 2400, Block 80 or attachment) and selection of an appropriate ICD-10-CM diagnosis code; DCIS (carcinoma in situ) codes are excluded and the Oncotype DX Breast and DCIS assays must not share the same Z-Code identifier.

"Oncotype DX Breast is intended for patients with estrogen-receptor (ER) positive, node-negative invasive carcinoma of the breast."

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