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

This policy allows immunohistochemical (IHC) testing for ER, PR, and Her-2/neu by IHC for patients with primary invasive breast cancer and for recurrent or metastatic breast cancer. Routine H&E staining is included in pathology services and is not separately billable; IHC testing must be reported using the specified CPT codes (88342/88341 for stains and 88360/88361 for analysis) with the indicated units of service, and each billing entity must document medical necessity.

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

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