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IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.
Content provided on this page contains outdated information and instruction and should not be considered current.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 This archived section contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.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 - Revised: 07.20.16

Immunohistochemistry (IHC) Indications for Breast Pathology (CM00035)

Based on recommendations from the College of American Pathologists, the American Society of Clinical Oncologists (ASCO), and the National Comprehensive Cancer Network (NCCN), hormone receptor assays, estrogen receptor (ER), progesterone receptor (PR), and Her-2/neu are the only current biomarkers that demonstrate standardized value in breast cancer pathology evaluation. Although other biomarkers, such as Ki-67, PI3K, and gene expression assays, have been studied, no proven standardized value has been established. Therefore, MolDX will reimburse ER, PR, and Her2 testing by IHC for patients with primary invasive breast cancers and recurrent or metastatic cancers.

To report an IHC service for an ER, PR, Her2, submit the following claim information:

HCPCS Codes Specimen UOS
88342 First single/multiplex stain 1
88341 Each additional 2

To report morphometric analysis, select one of the following codes based on the type of morphometric analysis:

CPT Codes Service type UOS
88360 Manual 3
88361 Computer-assisted 3

Effective January 1, 2014 thru 06/11/2015, CPT code 88342 and 88343 are not active for Medicare submission. Effective 06/12/2015, 88342 was reactivated by CMS for Medicare submission. CPT 88343 was deleted 01/01/2015. HCPCS codes G0461 and G0462 were deleted 01/01/2015.

Note: a unit of service applies to a single separately identifiable specimen.

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