LCDActive
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health)
L36941
Effective: November 25, 2021
Updated: December 31, 2025
Policy Summary
The Oncotype DX DCIS assay is covered only for women with a diagnosis of ductal carcinoma in situ (DCIS) who are planning breast-conserving surgery and are considering adjuvant radiation therapy. The provided excerpt restricts coverage to that specific clinical scenario; other uses or patient populations are not covered per the excerpt. Documentation and frequency limits are not specified here and require review of the full policy.
Coverage Criteria Preview
Key requirements from the full policy
"Oncotype DX® DCIS assay is covered for women diagnosed with ductal carcinoma in situ (DCIS) who are planning breast-conserving surgery and are considering adjuvant radiation therapy."
Sign up to see full coverage criteria, indications, and limitations.