MolDX: Biomarker Testing for Risk Stratification in DCIS

This contractor does not currently cover biomarker/molecular/proteomic tests for DCIS risk stratification unless a test and patient meet all specified criteria. Coverage may be considered only for patients with DCIS (no concurrent invasive carcinoma) who are candidates for breast-conserving management, have not had ipsilateral RT, have a treatment plan including RT with consent and an intent to forgo RT if classified as 'sufficiently low-risk,' and when the test has completed a Technical Assessment and demonstrates superior or equivalent peer‑reviewed evidence of identifying a low-risk group defined by an absolute IBTR risk reduction from RT of ≤5% compared with BCS alone.

"Patient has a diagnosis of ductal carcinoma in situ (DCIS) without concurrent invasive breast carcinoma."

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