Billing and Coding: MolDX: Breast Cancer Assay: Prosigna®

Prosigna® breast cancer assay must be billed using CPT 81520 and is covered only when the clinical criteria in MolDX LCD L36425 are met. Claims must report 1 unit of service, include the appropriate DEX Z-Code™ adjacent to the CPT code in the specified electronic or paper claim fields, and list an appropriate ICD-10-CM diagnosis supporting medical necessity.

"Prosigna® (breast cancer assay) services are billed when coverage criteria in the MolDX Local Coverage Determination L36425 are met and should be reported with CPT code 81520."

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