Summary & Overview
CPT 3376F: Breast Cancer Diagnosis, Stage II
CPT code 3376F indicates documentation that a female patient aged 18 or older has been diagnosed with stage II breast cancer, defined by specific tumor size and lymph node involvement criteria. Nationally, stage documentation codes like 3376F matter because they support care planning, quality measurement, and eligibility tracking for staging-dependent treatments and programs.
Key payers commonly relevant for CPT code 3376F include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers use staging documentation in authorization, quality reporting, and performance measurement workflows.
Readers will find a concise explanation of what CPT code 3376F represents, the clinical context for stage II breast cancer staging, and how the code is typically used across service lines such as oncology clinics and hospital outpatient departments. The publication also summarizes benchmarks, coding guidance, and policy considerations related to documentation and quality reporting where available.
Data not available in the input: detailed payer-specific coverage rules, common modifiers, associated taxonomies, related ICD-10 diagnosis codes, and service-line-level billing details.
Billing Code Overview
CPT code 3376F documents a diagnosis of breast cancer, female patient aged 18 or older, staged as II. The description specifies tumor size and nodal involvement criteria: tumor ≤5 cm with some spread to lymph nodes, or tumor >5 cm with no lymph node spread.
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Service type: Cancer diagnosis staging and documentation
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Typical site of service: Oncology clinic, hospital outpatient department, or specialty cancer center
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Clinical & Coding Specifications
Clinical Context
A typical patient is a female aged 18 years or older who presents after imaging and biopsy confirm invasive breast carcinoma. Clinical staging and multidisciplinary evaluation determine stage II disease: either a tumor ≤5 cm with regional lymph node involvement or a tumor >5 cm without nodal metastasis. The workflow includes history and physical, diagnostic mammography and ultrasound, core needle biopsy with pathology report, staging chest/abdomen imaging as indicated, and a breast surgery consultation. The surgeon documents tumor size, nodal status (clinical and pathologic), and the overall stage II designation in the medical record. Treatment planning commonly proceeds to lumpectomy with sentinel lymph node biopsy or mastectomy with axillary evaluation, coordinated with medical oncology for systemic therapy and radiation oncology for adjuvant radiation when indicated. Coding and billing use 3376F to reflect documentation of female breast cancer stage II in the chart, supporting quality reporting and severity documentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period | Use when unrelated E/M services are provided during the postoperative period of a surgical procedure unrelated to breast cancer care. |