The information in this article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for MolDX: Breast Cancer Index® (BCI) Gene Expression Test.
Effective 1/01/2019, MolDX will provide limited coverage for the BCI gene expression test.
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 ER+ and/or PR+ and HER2 -; and
- Patient has early-stage disease (T1-3, pN0-N1, M0); and
- Patient has no evidence of distant breast cancer metastasis (i.e., non-relapsed); and
- Test results will be used in determining treatment management of the patient for chemotherapy and/or endocrine therapy.
MolDX expects this test will be performed once per patient lifetime on formalin-fixed, paraffin-embedded (FFPE) tissue from the primary tumor specimen obtained prior to adjuvant treatment.
To report a BCI service, please submit the following claim information:
- Select CPT® code 81518
- Enter unit of service (UOS)
- Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT® code in the comment/narrative field for the following 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