Summary & Overview
CPT 3316F: Estrogen and Progesterone Receptor Assessment in Tumor Cells
CPT code 3316F represents the documentation that a provider has assessed estrogen receptor (ER) and progesterone receptor (PR) status in tumor cells of female patients aged 18 and older. Hormone receptor status is a critical determinant of eligibility for endocrine therapies and influences treatment planning and prognosis, making this measure clinically significant across oncology care settings. Nationally, standardized documentation of receptor testing supports consistent treatment decisions, quality measurement, and value-based payment programs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical context, typical sites of service, and how receptor assessment informs therapy selection. The publication also summarizes common billing considerations, related service lines, and the role of this assessment in quality measurement and reporting. Where available, benchmarks and payer coverage notes are presented; if payer-specific details are not provided in the source input, the publication indicates that data is not available in the input.
This brief equips clinicians, billing staff, and policy stakeholders with the essential facts about CPT code 3316F, why it matters in oncology care, and what to expect when this measure is used in documentation and reporting.
Billing Code Overview
CPT code 3316F documents an assessment for the presence of estrogen receptors (ER) or progesterone receptors (PR) in tumor cells of female patients age 18 or older. The measure indicates whether tumor cells express these hormone receptors, which is a key piece of clinical information used to determine responsiveness to hormone-directed therapies.
Service Type: Pathology / Tumor Biomarker Assessment
Typical Site of Service: Hospital outpatient pathology lab, hospital inpatient pathology services, or independent clinical laboratory
This code describes the provider's assessment of receptor status (ER and PR) in tumor tissue. A tumor that is ER– or PR– is noted as not responsive to medications that interfere with estrogen production or utilization. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult female (≥18 years) who presents with a biopsy-proven invasive breast carcinoma or ductal carcinoma in situ following imaging or palpable abnormality. The tumor specimen (core biopsy, excisional biopsy, or surgical resection) is submitted to anatomic pathology for receptor testing. The clinical workflow: the surgeon or radiologist obtains the tissue sample and sends it with requisition noting clinical indication and prior treatments; the pathology lab verifies specimen adequacy, processes tissue for histology, and performs immunohistochemistry (IHC) to assess estrogen receptor (ER) and/or progesterone receptor (PR) status. The pathologist interprets staining intensity and percentage of tumor cells positive, documents ER/PR results in the pathology report, and communicates findings to the treating oncologist to inform systemic therapy decisions. Typical site of service is an outpatient pathology laboratory or hospital-based surgical pathology service.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation portion of a test if the laboratory bills technical component separately. |
TC | Technical component |