J1 MAC: 84999 Covered

The Oncotype DX® Colon Cancer Assay meets criteria for analytical and clinical validity and clinical utility as a reasonable and necessary Medicare benefit, Palmetto GBA announced after completing a recent assessment.

Effective Sept. 18, 2011 the jurisdiction 1 Part B Medicare administrative contractor (J1-B MAC) says it will reimburse Oncotype DX® Colon Cancer Assay services for patients diagnosed with stage II colon cancer.

The Oncotype DX® Colon Cancer Assay, developed to predict the recurrence risk for patients with stage II colon cancer, is a 12-gene RT-PCR assay performed on paraffin-embedded primary colon tumor tissue.

2016 HCPCS Level

To report an Oncotype DX® Colon Cancer Assay service provided to a Medicare patient, Palmetto GBA requests providers to submit the following claim information:

  • CPT® code 84999 Unlisted chemistry procedure
  • Enter ‘Oncotype DX colon’ in the comment/narrative field
  • Select the appropriate ICD-9-CM code: 153.0-153.9, 154.0-154.2

Source: Palmetto GBA, “What’s New,” Sept. 29, 2011

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