Billing and Coding: Special Histochemical Stains and Immunohistochemical Stains

This A/B MAC guidance allows immunohistochemical (IHC) testing for ER, PR, and Her-2/neu for patients with primary invasive breast cancer and for recurrent/metastatic breast cancer, consistent with CAP/ASCO/NCCN recommendations. Routine H&E staining is included in pathology services and is not separately billable; claims must report specified CPT codes and units of service per separately identifiable specimen in accordance with LCD L35986.

"Immunohistochemical (IHC) testing for estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu is covered for patients with primary invasive breast cancer and for recurrent or metastatic b..."

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