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

Prosigna® billing requires reporting CPT code 81520 with 1 unit of service and inclusion of the appropriate ICD-10-CM diagnosis code. A DEX Z-Code identifier must be entered adjacent to the CPT code in the claim narrative using the specified fields for Part B (Loop 2400 / SV101-7 for 837P or Box 19 paper) and Part A (SV202-7 for 837I or Block 80 on UB04).

"Report the Prosigna® assay using CPT code 81520 on the claim."

Sign up to see full coverage criteria, indications, and limitations.