Billing and Coding: Lab: Special Histochemical Stains and Immunohistochemical Stains

This guidance allows immunohistochemical (IHC) testing for ER, PR, and HER2 in patients with primary invasive breast cancer and in recurrent or metastatic breast cancer, using the specified CPT codes and unit-of-service values. Hematoxylin and eosin (H&E) staining is part of routine pathology and is not separately billable; all billing must be consistent with LCD L36351 and supported by documentation of medical necessity, with each billing entity responsible for its submitted services.

"IHC testing for estrogen receptor (ER) is covered for patients with primary invasive breast cancer and for recurrent or metastatic breast cancer."

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