DRAFT LCD Reference Article Billing and Coding Article

Billing and Coding: Immunohistochemistry (IHC) Indications for Breast Pathology

DA59292

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Source Article ID
A59292
Draft Article ID
DA59292
Original ICD-9 Article ID
Not Applicable
Draft Article Title
Billing and Coding: Immunohistochemistry (IHC) Indications for Breast Pathology
Article Type
Billing and Coding
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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

Article Guidance

Article Text

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, this A/B MAC will allow 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:

CPT® Code 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® Code Service Type UOS
88360 Manual 3
88361 Computer-assisted 3

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

Response To Comments

Number Comment Response
1
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Coding Information

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Keywords

  • Immunohistochemistry
  • IHC