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

This policy allows immunohistochemical (IHC) testing for ER, PR, and HER2/neu by IHC for patients with primary invasive breast cancer and for recurrent or metastatic breast cancer, consistent with CAP/ASCO/NCCN recommendations. Routine H&E staining is included in pathology services and is not separately billable; claims should report the specified CPT codes (88342 for the first stain, 88341 for additional stains, and 88360/88361 for morphometric analysis) with the units of service noted in the policy, and the submitting entity must document medical necessity. Ambiguity in the listed units of service for additional stains should be confirmed with the payer.

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

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