Billing and Coding: MolDX: PIK3CA Gene Tests

PIK3CA targeted gene sequencing is supported for postmenopausal women and men with HR-positive, HER2-negative advanced or metastatic breast cancer who progressed on or after an endocrine-based regimen to identify eligibility for FDA-approved alpelisib (Piqray). The test should be an FDA-approved PIK3CA diagnostic, and claims must include the appropriate CPT code, diagnosis, and a DEX Z-Code™ placed adjacent to the CPT code in the specified electronic or paper claim fields.

"PIK3CA targeted gene sequencing is covered to detect PIK3CA mutations in postmenopausal women and men with hormone receptor (HR)-positive, HER2-negative advanced or metastatic breast cancer who hav..."

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