CPT® Code 86300 is used to report quantitative measurement of Cancer Antigen 15-3 (CA 15-3) using an immunoassay method. CA 15-3 is a tumor marker most commonly associated with breast cancer, and is used to monitor disease progression, treatment response, and recurrence.
This code represents the laboratory assay only, not specimen collection or interpretation services, which may be reported separately when appropriate.
Key Facts About CPT® 86300
- Service type: Laboratory test (oncology marker)
- Test: CA 15-3 (quantitative immunoassay)
- Specimen type: Serum or plasma
- Test purpose: Monitor breast cancer and related conditions
- Provider type: Laboratories, physicians, and qualified healthcare professionals
Common clinical indications:
- Monitoring treatment response in breast cancer
- Surveillance for recurrence
- Follow-up of previously elevated CA 15-3 levels
- Assessment of metastatic disease progression
- Adjunct to imaging and clinical evaluation
When to Use CPT® 86300
CPT 86300 is appropriate when:
- Measuring CA 15-3 levels quantitatively
- Monitoring patients with known breast cancer
- Tracking treatment response or recurrence
- Evaluating tumor marker trends alongside clinical findings
Examples:
- Serial CA 15-3 testing during chemotherapy or targeted therapy
- Monitoring for recurrence after breast cancer treatment
- Assessing disease progression in metastatic breast cancer
- Following tumor marker trends over time
Documentation Requirements
To support CPT 86300 billing, documentation should include:
- Patient identifiers and date of service
- Clinical indication for testing
- Relevant diagnosis or cancer history
- Specimen type (serum or plasma)
- Test performed (CA 15-3 quantitative immunoassay)
- Test result and date reported
- Ordering provider information
Clear documentation supports medical necessity, particularly for ongoing monitoring.
Reimbursement and Coding Considerations
- CPT 86300 is generally covered when medically necessary, especially for cancer monitoring
- Not typically recommended as a screening test in asymptomatic patients
- Often performed as serial testing, requiring documentation of medical necessity
- Diagnosis coding should reflect breast cancer or related conditions
- May be subject to payer frequency limitations
Always verify payer-specific oncology testing guidelines.
How OptiMantra Supports Tumor Marker Testing
OptiMantra’s integrated EMR and practice management system streamlines documentation and billing for CPT 86300:
With OptiMantra, providers can:
- Order CA 15-3 testing within the patient chart
- Track tumor marker trends over time
- Link lab results to oncology diagnoses and treatment plans
- Maintain organized laboratory documentation that supports billing compliance and audit preparedness
- Integrate lab monitoring into comprehensive care workflows
By centralizing oncology lab workflows, OptiMantra helps practices improve efficiency, ensure compliance, and optimize reimbursement.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
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