2020 CPT Code Additions for Pathology

80145, 80187, 80230, 80235, 80280, 80285, 81277, 81522, 81552, 87563

All Pathology Add codes Modifiers 33, 90, and 99 are allowed.

• 80145, 80230 One of the following ICD-10-CM diagnosis codes is required on the claim: H20.041 – H20.049, K50.00 – K50.919, K51.00 – K51.919, L40.0 – L40.9, L73.2, L88, M05.00 – M05.09, M05.20 – M06.39, M06.80 – M06.9, M08.00 – M08.99, M35.2 or M45.0 – M45.9.
• 80235 One of the following ICD-10-CM diagnosis codes is required on the claim: G40.001 – G40.219. 80280 One of the following ICD-10-CM diagnosis codes is required on the claim: K50.011 – K51.319. 81522
• CPT code 81522 is limited to once in a lifetime for any provider and may not be overridden by a Treatment Authorization Request (TAR). A TAR is required with documentation of the following criteria: • The recipient is estrogen and progesterone receptor (ER/PgR)-positive. • The recipient is HER2-receptor negative. • The recipient is lymph node negative. • The recipient has stage I or stage II breast cancer. • The recipient is a candidate for chemotherapy. • The assay is used within six months of diagnosis. • The recipient is under consideration for adjuvant systemic therapy.
• CPT code 81522 when billing for EndoPredict.
• 81552 CPT code 81552 is limited to once in a lifetime for any provider and may not be overridden by a TAR. One of the following ICD-10-CM diagnosis codes is required on the claim: C69.30 – C69.32 or C69.40 – C69.42. 87563 One of the following ICD-10-CM diagnosis codes is required on the claim: N34.0 – N34.3 or N70.01 – N77.1