Billing and Coding: BRCA1 and BRCA2 Genetic Testing

Coverage for BRCA1/BRCA2 testing is determined by the clinical criteria in LCD L36499 and must be reasonable and necessary per that LCD. Billing must follow coding guidance (use CPT 81479 with the specified comment for duplication/deletion panels), utilization should follow local standards per CMS Ruling 95-1, and complete, legible medical record documentation supporting ICD-10 and CPT/HCPCS codes is required.

"BRCA1 and BRCA2 genetic testing is covered when reasonable and necessary per Local Coverage Determination L36499 clinical criteria."

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