About this policy
The following coding and billing guidance is to be used with its associated Local coverage determination. NOTE: The Oncotype DX Breast Cancer Assay and the Oncotype DX DCIS Score are different tests and should NOT be submitted with the same Z-Code Identifier. Because this article ONLY addresses Oncotype DX Breast, the diagnosis codes for breast carcinoma in situ have been removed. Oncotype DX ® Breast was developed for patients with the following findings: estrogen-receptor positive, node-negative carcinoma of the breast estrogen-receptor positive micrometastases of carcinoma of the breast, and estrogen-receptor positive breast carcinoma with 1-3 positive nodes. To bill an Oncotype Breast service, please provide the following claim information: Enter “1” in the Days/Unit field Select the appropriate ICD-10-CM code Enter Z-Code™ Identifier in the comment/narrative field for the following Part B claim field/types: Loop 2400 or SV101-7 for the 5010A1 837P Item 19 for paper claim Enter Z-Code™ Identifier in the comment/narrative field for the following Part A claim field/types: Line SV202-7 for 837I electronic claim Block 80 for the UB04 claim form
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 81519 | HCPCS | Covered |
| C50.011 | ICD10CM | Covered |
| C50.012 | ICD10CM | Covered |
| C50.019 | ICD10CM | Covered |
| C50.021 | ICD10CM | Covered |
| C50.022 | ICD10CM | Covered |
| C50.029 | ICD10CM | Covered |
| C50.111 | ICD10CM | Covered |
| C50.112 | ICD10CM | Covered |
| C50.119 | ICD10CM | Covered |
| C50.121 | ICD10CM | Covered |
| C50.122 | ICD10CM | Covered |