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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

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

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