Question 1

What is HCPCS code S3854?

Accepted Answer

HCPCS code S3854 is "Gene profile panel breast". Gene expression profiling panel for use in the management of breast cancer treatment

Question 2

What category is S3854 in?

Accepted Answer

S3854 belongs to HCPCS Category S (Temporary National Codes (Non-Medicare)).

Question 3

When should I use HCPCS code S3854?

Accepted Answer

Use S3854 when billing for gene profile panel breast. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is S3854 covered by Medicare?

Accepted Answer

Coverage for S3854 (Gene profile panel breast) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for S3854?

Accepted Answer

Documentation for S3854 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).