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 invasive, ER+ and/or PR+, HER2- early-stage breast cancer (T1-T3, pN0-pN1, M0) when results will inform adjuvant chemotherapy decisions or extension of endocrine therapy. The test must be performed once per patient lifetime on FFPE tissue from the primary tumor obtained prior to adjuvant treatment; claims must use CPT 81518 with required Z-code/DEX Z-Code entries and appropriate ICD-10 diagnosis codes. Note: the policy text contains a potential internal inconsistency regarding nodal status (pN0-pN1 vs an explicit statement that the patient is lymph node negative); this item may require manual review.

"Postmenopausal women with invasive carcinoma of the breast that is estrogen receptor (ER) positive and/or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 (HER2) neg..."