Summary & Overview
CPT 83950: HER2/neu Serum Tumor Marker Assay
CPT code 83950 represents a laboratory assay that measures the HER2/neu oncoprotein in serum. The test is clinically relevant for monitoring patients with a prior breast cancer diagnosis, offering a minimally invasive method to track tumor marker levels over time. Nationally, HER2 monitoring supports oncologists in assessing disease progression or response to therapy and can inform follow-up care decisions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, plus what to expect in payer coverage discussions and common billing considerations. The publication outlines benchmarks and payment policy themes relevant to laboratory oncology testing, summarizes typical sites of service, and highlights where additional coding or documentation details may be required. This resource is intended to help billing professionals, laboratory managers, and clinical teams understand the role of CPT code 83950 in cancer monitoring workflows and payer interactions.
Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific reimbursement rates.
Billing Code Overview
CPT code 83950 describes a laboratory test that measures the HER2/neu oncoprotein, typically in a serum specimen. This assay is used to assess circulating levels of the HER2 protein for patients with a history of breast cancer and is commonly ordered for follow-up or monitoring of a previous breast cancer diagnosis.
-
Service type: Laboratory—serologic tumor marker assay
-
Typical site of service: Clinical laboratory, hospital laboratory, or outpatient laboratory collection site
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a history of invasive ductal breast carcinoma status-post lumpectomy and adjuvant chemotherapy presents for routine oncology follow-up. The treating medical oncologist orders a serum HER2/neu oncoprotein test to monitor tumor marker trends and assess for biochemical evidence of recurrence or progression. A phlebotomist draws a serum specimen in the outpatient laboratory; the specimen is sent to the clinical chemistry lab where a laboratory analyst performs the quantitative immunoassay for HER2/neu (C-erbB-2) protein concentration. Results are reported in the electronic health record to the oncologist, who interprets the values in conjunction with imaging, clinical exam, and prior HER2 measurements to inform surveillance or potential therapy adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional Component | Use when billing only the professional interpretation/reporting component and the facility bills for technical component. |
90 | Reference (Outside) Laboratory | Use when the specimen is sent to an outside reference laboratory for testing. |