MolDX: EndoPredict® Breast Cancer Gene Expression Test

This contractor provides limited coverage of the EndoPredict gene expression test for post-menopausal women with early-stage (T1-T3, N0-N1) ER-positive, HER2-negative breast cancer (lymph node-negative or 1-3 positive nodes) when adjuvant endocrine therapy is being considered. The test is intended to identify patients with sufficiently low 10-year distant recurrence risk who may safely avoid chemotherapy. Coverage, required documentation, and any prior authorization or frequency limits should be confirmed with the contractor for cases outside these specified criteria.

"Covered for post-menopausal women with early-stage (TNM T1-T3, N0-N1) estrogen receptor (ER) positive, HER2-negative primary breast cancer who are lymph node-negative or have 1-3 positive nodes, wh..."

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