About this policy
Jurisdiction: J8 MAC Part B. States: Indiana, Michigan. Type: Active LCD
Coverage indications
This Medicare contractor will provide limited coverage for the Breast Cancer Index ® (BCI) gene expression test (Biotheranostics, Inc., San Diego, CA). The BCI test is used by physicians to provide a genomic-based estimate of distant recurrence risk when considering addition of chemotherapy, and/or late distant recurrence risk and endocrine responsiveness when considering extension of endocrine therapy, depending upon when in the continuum of care testing is requested. The BCI test is covered for postmenopausal women with invasive breast cancer when the following criteria are met: Pathology reveals invasive carcinoma of the breast that is estrogen-receptor positive (ER+) and/or progesterone receptor positive (PR+) and Human Epidermal Growth Factor Receptor 2 negative (HER2-); and Patient has early-stage disease {Tumor, Node, Metastasis (TNM) stage T1-3, pN0-N1, M0}; and Patient has no evidence of distant breast cancer metastasis (i.eg., non-relapsed); and Test results will be used in determining treatment management of the patient for chemotherapy and/or endocrine therapy.
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 |
|---|---|---|
| 81518 | CPT | Covered |
| C50.011 | ICD10CM | Covered |
| C50.012 | ICD10CM | Covered |
| C50.111 | ICD10CM | Covered |
| C50.112 | ICD10CM | Covered |
| C50.211 | ICD10CM | Covered |
| C50.212 | ICD10CM | Covered |
| C50.311 | ICD10CM | Covered |
| C50.312 | ICD10CM | Covered |
| C50.411 | ICD10CM | Covered |
| C50.412 | ICD10CM | Covered |
| C50.511 | ICD10CM | Covered |