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+]