Updated Early Stage Breast Cancer Documentation Criteria

Effective for dates of service on or after October 1, 2015, documentation for the reimbursement of CPT code 81519 (oncology, mRNA, gene expression profiling by real time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score) must indicate that the recipient is either lymph node negative, or has 1 – 3 involved ipsilateral axillary lymph nodes. Providers may refer to the Pathology: Molecular Pathology section in the provider manual for the full text of required documentation.