MolDX: Breast Cancer Assay: Prosigna®

Prosigna (PAM50) testing is covered only for post-menopausal females with ER-positive early breast cancer who are either node-negative (stage I or II) or node-positive with 1-3 positive nodes (stage II). Claims that do not meet all of these FDA-aligned criteria will be denied; the policy does not specify additional frequency limits but requires documentation confirming menopausal status, ER positivity, tumor stage, and lymph node count.

"Post-menopausal female with estrogen receptor (ER) positive, node-negative breast cancer, stage I or II."

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