LCD/NCD Portal
Automated World Health
NCD190.25 ALPHA-FETOPROTEIN
Effective Date of this Version
1/1/2003
Benefit Category
• Diagnostic Laboratory Tests.
• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
Item/Service Description
• AFP is a polysaccharide found in some carcinomas.
• It is effective as a biochemical marker for monitoring the response of certain malignancies to therapy.
Indications and Limitations of Coverage
• AFP is useful for the diagnosis of hepatocellular carcinoma:
o In high-risk patients:
Alcoholic cirrhosis.
Cirrhosis of viral etiology.
Hemochromatosis.
Alpha 1-antitrypsin deficiency.
o In separating patients with
Benign hepatocellular neoplasms.
Metastases from those with hepatocellular carcinoma.
o As a non-specific tumor associated antigen, serves in marking germ cell neoplasms of the:
Testis.
Ovary.
Retro peritoneum.
Mediastinum.
• Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).
Cross Reference
• Also see the Medicare Claims Processing Manual, Chapter 120, Clinical Laboratory Services Based on Negotiated Rulemaking.
Coverage Transmittal Link
• http://www.cms.gov/transmittals/downloads/R17NCD.pdf
Other
Covered Code Lists (including narrative)
• January 2013
October 2012
July 2012
April 2012
January 2012
October 2011
July 2011
April 2011
January 2011
October 2010
July 2010
April 2010
January 2010
October 2009
July 2009
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January 2009
October 2008
July 2008
April 2007
January 2007
Changes to Lab NCD Edit Software
• January 2012
October 2011
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