Summary & Overview
HCPCS M1410: No BRCA1/BRCA2 Germline Testing or Genetic Counseling
HCPCS Level II code M1410 denotes patients who did not receive germline testing for BRCA1 and BRCA2 or complete genetic counseling within six months of a qualifying diagnosis. The code captures a gap in adherence to recommended hereditary cancer risk assessment pathways and is used to flag care quality and documentation deficiencies at the patient level. Nationally, timely BRCA testing and counseling affect treatment planning, risk-reduction strategies, and family cascade testing, making this measure salient for oncology care quality frameworks.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the measure's clinical context, the typical settings where services are delivered, and the implications for documentation and quality reporting. The publication outlines common benchmarking topics, potential policy considerations related to coverage and quality metrics, and the clinical relevance for oncology and genetic services. Data not available in the input for associated taxonomies, specific ICD-10 mappings, related codes, and payer-specific reimbursement details are noted as unavailable.
Billing Code Overview
HCPCS Level II code M1410 identifies patients who did not have germline testing for BRCA1 and BRCA2 or genetic counseling completed within six months of diagnosis. This measure pertains to the absence of documented genetic risk assessment and testing for hereditary breast and ovarian cancer genes.
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Service type: Genetic counseling and germline genetic testing coordination and documentation
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Typical site of service: Oncology clinics, breast centers, genetic counseling clinics, and outpatient ambulatory settings
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Clinical & Coding Specifications
Clinical Context
A typical patient is a woman newly diagnosed with invasive breast cancer or high-grade ductal carcinoma in situ who has not completed germline BRCA1/BRCA2 testing or genetic counseling within six months of diagnosis. The patient presents to a multidisciplinary breast oncology clinic following surgical consultation. The clinical workflow begins with the breast surgeon or medical oncologist documenting family history and assessing hereditary cancer risk. Because BRCA status influences systemic therapy selection, surgical planning (including consideration of bilateral mastectomy), and eligibility for PARP inhibitors, the clinician orders genetic counseling referral and germline testing. Administrative staff schedule the counseling visit; samples are collected either in clinic or via kit sent to the patient. Results are routed back to the ordering clinician and genetic counselor for integration into the treatment plan. If testing or counseling is not completed within six months, the billing descriptor applies and is used for tracking quality measures and care gap reporting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity for coordination of genetic testing or counseling is substantially greater than typical (rare for this code). |
23 | Unusual anesthesia | Use if unusual anesthesia is required during specimen collection for genetic testing (rare).