Summary & Overview
CPT 3380F: Breast Cancer, Stage IV with Distant Metastasis
CPT code 3380F represents documentation that a female patient aged 18 years or older has stage IV breast cancer, specifying that the tumor may be any size and that distant metastases are present. As a clinical staging code, it matters nationally because accurate staging documentation guides oncology treatment planning, supports appropriate care coordination, and informs claims processing and quality measurement for advanced breast cancer.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and coding intent, typical sites of service where this documentation is recorded, and what to expect in payer coverage and claims workflows when stage IV breast cancer is documented. The publication also outlines benchmarks and policy updates relevant to cancer staging documentation, clarifies how such documentation interacts with quality measurement and reporting, and highlights practical implications for billing and clinical records.
Data not available in the input for specific modifiers, associated taxonomies, ICD-10 mappings, related codes, and service line detail. The content provides a national-level perspective on the role of CPT code 3380F in oncology documentation and billing processes.
Billing Code Overview
CPT code 3380F documents a diagnosis of breast cancer, stage IV, for a female patient aged 18 years or older. The code indicates that the tumor may be of any size and that distant metastases are present, reflecting advanced-stage disease.
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Service type: Diagnosis and cancer staging documentation
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Typical site of service: Oncology clinic, hospital inpatient or outpatient oncology service, or multidisciplinary cancer center
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Clinical & Coding Specifications
Clinical Context
A typical patient is a female aged 18 years or older who presents to an oncology clinic or hospital-based cancer center after diagnosis of metastatic breast cancer. She has histologically confirmed primary breast carcinoma with evidence of distant metastasis on staging studies (CT chest/abdomen/pelvis, PET-CT, bone scan, or brain MRI) and is documented as Stage IV in the medical record. The clinical workflow includes initial oncologic evaluation, staging confirmation, multidisciplinary tumor board review, initiation or adjustment of systemic therapy (chemotherapy, targeted therapy, endocrine therapy, or immunotherapy), palliative interventions as needed, and ongoing symptom management. Encounters where 3380F is reported typically occur during new patient oncology consultations, follow-up visits to document progression to stage IV, transitions of care when metastatic disease is first confirmed, or periodic documentation required for care planning, prognosis discussions, and eligibility for certain treatments or supportive services. Typical sites of service include outpatient oncology clinics, hospital outpatient departments, and inpatient oncology wards when staging or treatment changes occur.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed on the same day as a procedure or service and is distinct from the service associated with documentation |