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

This billing guideline specifies that the Prosigna® breast cancer assay must be billed using CPT 81520 with 1 unit of service and the appropriate ICD-10-CM diagnosis code. Claims must include the DEX Z-Code™ identifier adjacent to the CPT code in the designated comment/narrative fields for Part B (Loop 2400/SV101-7 or Box 19) and Part A (SV202-7 or Block 80) claim types; coverage and clinical eligibility are determined by LCD MolDX: Breast Cancer Assay: Prosigna® (L36811).

"Report the Prosigna® breast cancer assay using CPT code 81520 when the test is performed per coverage criteria in LCD MolDX: Breast Cancer Assay: Prosigna® (L36811)."

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