LCDActive
MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health)
L37199
Wisconsin Physicians Service Insurance Corporation (J05)
Effective: October 30, 2025
Updated: December 31, 2025
Policy Summary
The Oncotype DX DCIS assay is covered only for women with ductal carcinoma in situ who plan breast-conserving surgery and are considering adjuvant radiation therapy. Coverage is restricted to this specific clinical scenario and is not provided for other indications. Medical records should document the DCIS diagnosis and the planned surgical and radiation treatment considerations.
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.