LCD/NCD Portal
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NCD190.29 TUMOR ANTIGEN BY IMMUNOASSAY - CA 15-3/CA 27.29
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
• Immunoassay determinations of the serum levels of certain proteins or carbohydrates serve as tumor markers.
• When elevated, serum concentration of these markers may reflect tumor size and grade.
• This policy specifically addresses the following tumor antigens: CA 15-3 and CA 27.29
Indications and Limitations of Coverage
Indications
• Multiple tumor markers are available for monitoring the:
o Response of certain malignancies to therapy.
o Assessing whether residual tumor exists post-surgical therapy.
• CA 15-3 is often medically necessary to aid in the management of patients with breast cancer.
o Serial testing must be used in conjunction with other clinical methods for monitoring breast cancer.
o For monitoring, if medically necessary, use consistently either CA 15-3 or CA 27.29, NOT both.
• CA 27.29 is equivalent to CA 15-3 in its usage in management of patients with breast cancer.
Limitations
• These services are NOT covered for the evaluation of patients with signs or symptoms suggestive of malignancy.
o The service may be ordered at times necessary to assess either the presence of recurrent disease or the patient's response to treatment with subsequent treatment cycles.
• 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
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