Skip to Main Content

Print | Bookmark | Email | Font Size: + |

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.
Content provided on this page contains outdated information and instruction and should not be considered current. CGS is providing this archived information for research purposes only. This archived section contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

October 12, 2015 - Updated 01.13.16

Oncotype DX Breast Cancer Assay Coding and Billing Guidelines (CM00024, V3)

Note: The OncotypeDX Breast Cancer Assay and the OncotypeDX DCIS Score are different tests and should NOT be submitted with the same Z-Code Identifier. Because this article ONLY addresses OncotypeDX 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:

  • Claims received prior to 1/1/2015: CPT code 81479 - unlisted molecular pathology
  • Claims received on and after 1/1/2015: CPT code 81519 - Oncology (breast)
  • Enter '1' in the Days/Unit field

Enter assigned Z-Code™ Identifier n the comment/narrative field for the following claim field/types:

  • Loop 2300 NTE 01 for part A or Loop 2400 or SV101-7 for Part B
  • Submit assigned Z-Code™ Identifier on an attachment to the claim form for paper claim (Form locator 80 for Part A or Box 19 for Part B)

Select the appropriate ICD-9-CM code:

  • 174.0-174.8 - Malignant neoplasm of nipple and areola of female breast - Malignant neoplasm of other specified sites of female breast,
  • 174.9 - Malignant neoplasm of Breast (Female) unspecified site,
  • 175.0 - Malignant Neoplasm of Nipple and areola of Male Breast,
  • 175.9 - Malignant Neoplasm of other and unspecified sites of male breast,
  • V86.0 - Estrogen Receptor Positive status [ER+]

Select the appropriate ICD-10-CM codes:

  • C50.011 - Malignant neoplasm of nipple and areola, right female breast
  • C50.012 - Malignant neoplasm of nipple and areola, left female breast
  • C50.019 - Malignant neoplasm of nipple and areola, unspecified female breast
  • C50.021 - Malignant neoplasm of nipple and areola, right male breast
  • C50.022 - Malignant neoplasm of nipple and areola, left male breast
  • C50.029 - Malignant neoplasm of nipple and areola, unspecified male breast
  • C50.111 - Malignant neoplasm of central portion of right female breast
  • C50.112 - Malignant neoplasm of central portion of left female breast
  • C50.119 - Malignant neoplasm of central portion of unspecified female breast
  • C50.121 - Malignant neoplasm of central portion of right male breast
  • C50.122 - Malignant neoplasm of central portion of left male breast
  • C50.129 - Malignant neoplasm of central portion of unspecified male breast
  • C50.211 - Malignant neoplasm of upper-inner quadrant of right female breast
  • C50.212 - Malignant neoplasm of upper-inner quadrant of left female breast
  • C50.219 - Malignant neoplasm of upper-inner quadrant of unspecified female breast
  • C50.221 - Malignant neoplasm of upper-inner quadrant of right male breast
  • C50.222 - Malignant neoplasm of upper-inner quadrant of left male breast
  • C50.229 - Malignant neoplasm of upper-inner quadrant of unspecified male breast
  • C50.311 - Malignant neoplasm of lower-inner quadrant of right female breast
  • C50.312 - Malignant neoplasm of lower-inner quadrant of left female breast
  • C50.319 - Malignant neoplasm of lower-inner quadrant of unspecified female breast
  • C50.321 - Malignant neoplasm of lower-inner quadrant of right male breast
  • C50.322 - Malignant neoplasm of lower-inner quadrant of left male breast
  • C50.329 - Malignant neoplasm of lower-inner quadrant of unspecified male breast
  • C50.411 - Malignant neoplasm of upper-outer quadrant of right female breast
  • C50.412 - Malignant neoplasm of upper-outer quadrant of left female breast
  • C50.419 - Malignant neoplasm of upper-outer quadrant of unspecified female breast
  • C50.421 - Malignant neoplasm of upper-outer quadrant of right male breast
  • C50.422 - Malignant neoplasm of upper-outer quadrant of left male breast
  • C50.429 - Malignant neoplasm of upper-outer quadrant of unspecified male breast
  • C50.511 - Malignant neoplasm of lower-outer quadrant of right female breast
  • C50.512 - Malignant neoplasm of lower-outer quadrant of left female breast
  • C50.519 - Malignant neoplasm of lower-outer quadrant of unspecified female breast
  • C50.521 - Malignant neoplasm of lower-outer quadrant of right male breast
  • C50.522 - Malignant neoplasm of lower-outer quadrant of left male breast
  • C50.529 - Malignant neoplasm of lower-outer quadrant of unspecified male breast
  • C50.611 - Malignant neoplasm of axillary tail of right female breast
  • C50.612 - Malignant neoplasm of axillary tail of left female breast
  • C50.619 - Malignant neoplasm of axillary tail of unspecified female breast
  • C50.621 - Malignant neoplasm of axillary tail of right male breast
  • C50.622 - Malignant neoplasm of axillary tail of left male breast
  • C50.629 - Malignant neoplasm of axillary tail of unspecified male breast
  • C50.811 - Malignant neoplasm of overlapping sites of right female breast
  • C50.812 - Malignant neoplasm of overlapping sites of left female breast
  • C50.819 - Malignant neoplasm of overlapping sites of unspecified female breast
  • C50.821 - Malignant neoplasm of overlapping sites of right male breast
  • C50.822 - Malignant neoplasm of overlapping sites of left male breast
  • C50.829 - Malignant neoplasm of overlapping sites of unspecified male breast
  • C50.911 - Malignant neoplasm of unspecified site of right female breast
  • C50.912 - Malignant neoplasm of unspecified site of left female breast
  • C50.919 - Malignant neoplasm of unspecified site of unspecified female breast
  • C50.921 - Malignant neoplasm of unspecified site of right male breast
  • C50.922 - Malignant neoplasm of unspecified site of left male breast
  • C50.929 - Malignant neoplasm of unspecified site of unspecified male breast
  • Z17.0 Estrogen receptor positive status [ER+]

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved