Eligibility for Medicare funded testing using item 73295 and item 73296. Who is eligible and when should you test?
The executive summary is:
- use item 73296 at diagnosis if the patient meets the 10% likelihood criteria (includes all triple negative breast cancer, breast cancer < age 40, male breast cancer or if there is Ashkenazi heritage)
- use item 73295 after surgery in ER positive HER2 negative patients who have 4 or more positive lymph nodes who will be having adjuvant chemotherapy and who would be considered suitable for Olaparib if BRCA positive
- use item 73295 in ER positive HER2 negative patients post neoadjuvant chemotherapy and after surgery if there is residual disease and considered suitable for Olaparib if BRCA positive
- use item 73295 in ER positive HER2 negative patients during neoadjuvant chemotherapy and before surgery after discussion and agreement at an MDT that the patient has high risk disease (at least grade 3 or 1 node or >2cm) AND would be suitable for Olaparib AND is likely to have residual disease post chemotherapy AND it is unlikely that a result would be available in a timely manner (12 weeks) if testing were to be delayed until post surgery.
- Do NOT use item 73295 if the patient is not suitable for either chemotherapy or Olaparib.
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