October 12, 2015 - Revised 05.17.17
Oncotype DX Colon Cancer Assay Coding and Billing Guidelines (CM00026, V5)
The Oncotype DX® Colon Cancer Assay, developed to predict the recurrence risk for patients with Stage II colon cancer, has been assigned a unique identifier. To bill an Oncotype DX Colon service, please provide the following claim information:
01/01/2016 and forward CPT code 81525 – Oncology (colon), mRNA gene expression of 21 genes
- Enter '1' in the Days/Unit field
- For CPT non-NOC codes, Labs may either use the SV101-7 or SV202-7 (preferred) or the NTE field to submit this required information.
- Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
- Loop 2400 or SV101-7 for the 5010A1 837P
- Box 19 for paper claim
- Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code 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
- Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for the following Part B claim field/types:
Select the appropriate ICD-10-CM code:
- C18.3 – Malignant neoplasm of hepatic flexure
- C18.4 – Malignant neoplasm of transverse colon
- C18.6 – Malignant neoplasm of descending colon
- C18.7 – Malignant neoplasm of sigmoid colon
- C18.0 – Malignant neoplasm of cecum
- C18.1 – Malignant neoplasm of appendix
- C18.2 – Malignant neoplasm of ascending colon
- C18.5 – Malignant neoplasm of splenic flexure
- C18.8 – Malignant neoplasm of overlapping sites of colon
- C18.9 – Malignant neoplasm of colon, unspecified
- C19 – Malignant neoplasm of rectosigmoid junction
- C20 – Malignant neoplasm of rectum
- C21.1 – Malignant neoplasm of anal canal