Medi-Cal-Updated TAR Requirements for Gene Expression Profiling for Breast Cancer

Effective for dates of service on or after June 1, 2016, CPT codes 81519 (oncology [breast], mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score) and 81599 (unlisted multianalyte assay with algorithmic analysis) are Medi-Cal benefits. Codes 81519 and 81599 have a frequency limit of once in a lifetime and require a Treatment Authorization Request (TAR) with specific documentation requirements.