Corporate
IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.
Content provided on this page contains outdated information and instruction and should not be considered current.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 This archived section contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.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 5, 2015 - Revised: 05.17.17

HERmark Assay by Monogram Coding and Billing Guidelines (CM00016, V2)

The MolDX Team has completed the HERmark assessment and determined that the test meets criteria for analytical and clinical validity, and clinical utility as a reasonable and necessary Medicare benefit. Effective December 9, 2011, MolDX will reimburse services for HERmark.

To report a HERmark service, submit the following:

  • CPT code 81479 - Unlisted chemistry procedure
  • 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 at least one diagnosis code
    • 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
      • C50.021 Malignant neoplasm of nipple and areola, right male breast
      • C50.022 Malignant neoplasm of nipple and areola, left male breast
      • C50.111 Malignant neoplasm of central portion of right female breast
      • C50.112 Malignant neoplasm of central portion of left female breast
      • C50.121 Malignant neoplasm of central portion of right male breast
      • C50.122 Malignant neoplasm of central portion of left 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
      • C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
      • C50.222 Malignant neoplasm of upper-inner quadrant of left 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
      • C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
      • C50.322 Malignant neoplasm of lower-inner quadrant of left 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
      • C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
      • C50.422 Malignant neoplasm of upper-outer quadrant of left 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
      • C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
      • C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
      • C50.611 Malignant neoplasm of axillary tail of right female breast
      • C50.612 Malignant neoplasm of axillary tail of left female breast
      • C50.621 Malignant neoplasm of axillary tail of right male breast
      • C50.622 Malignant neoplasm of axillary tail of left male breast
      • C50.811 Malignant neoplasm of other specified sites of right female breast
      • C50.812 Malignant neoplasm of other specified sites of left female breast
      • C50.821 Malignant neoplasm of overlapping sites of right male breast
      • C50.822 Malignant neoplasm of overlapping sites of left male breast
      • C50.911 Malignant neoplasm of unspecified site of right female breast
      • C50.912 Malignant neoplasm of unspecified site of left female breast
      • C50.921 Malignant neoplasm of unspecified site of right male breast
      • C50.922 Malignant neoplasm of unspecified site of left male breast
      • C79.81 Secondary malignant neoplasm of breast

Was this page helpful? YES NO


Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved