MolDX: Biomarker Testing for Risk Stratification in DCIS

This contractor currently does not cover biomarker (molecular or proteomic) tests for DCIS risk stratification unless all specified criteria are met. Coverage may be considered only for patients with DCIS (no concurrent invasive disease), not candidates for mastectomy, no prior ipsilateral breast RT, not previously tested, with a treatment plan including RT and consent to forgo RT if deemed sufficiently low risk, where the test has completed a Technical Assessment and demonstrated superior or equivalent accuracy in peer-reviewed studies; sufficiently low-risk is defined as an absolute IBTR risk reduction from RT of 5% or less versus BCS alone.

"Patient has a diagnosis of ductal carcinoma in situ (DCIS) and does NOT have concurrent invasive breast carcinoma."

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