Billing and Coding: MolDX: Breast Cancer Index® (BCI) Gene Expression Test

MolDX provides limited coverage for the Breast Cancer Index (BCI) gene expression test for postmenopausal women with ER+ and/or PR+ and HER2- invasive breast carcinoma who have early-stage disease (T1-3, pN0-pN1, M0) and no distant metastasis, when results will inform chemotherapy and/or endocrine therapy decisions. The test must be run once in the patient's lifetime on FFPE primary tumor tissue obtained prior to adjuvant treatment; billing requires CPT 81518 (1 UOS), appropriate ICD-10-CM code(s), and placement of the DEX Z-Code™ identifier in the specified claim fields.

"Test is covered for postmenopausal women with invasive carcinoma of the breast that is estrogen receptor positive (ER+) and/or progesterone receptor positive (PR+) and human epidermal growth factor..."

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