NCD190.26

 

CARCINOEMBRYONIC ANTIGEN

 

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

• CEA is a protein 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

 

Indications

• CEA may be medically necessary for follow-up of patients with colorectal carcinoma.

o It would however only be medically necessary at treatment decision-making points.

o In some clinical situations (e.g. adenocarcinoma of the lung, small cell carcinoma of the lung, and some gastrointestinal carcinomas) when a more specific marker is not expressed by the tumor, CEA may be a medically necessary alternative marker for monitoring.

o Preoperative CEA may also be helpful in determining the post-operative adequacy of surgical resection and subsequent medical management.

o In general, a single tumor marker will suffice in following patients with colorectal carcinoma or other malignancies that express such tumor markers.

• In following patients who have had treatment for colorectal carcinoma, ASCO guideline suggests that:

o if resection of liver metastasis would be indicated:

 It is recommended that post-operative CEA testing be performed:

• Every two to three months in patients with initial stage II or stage III disease.

• For at least two years after diagnosis.

• For patients with metastatic solid tumors which express CEA:

o CEA may be measured at the start of the treatment.

o With subsequent treatment cycles to assess the tumor's response to therapy.

 

Limitations

• Serum CEA determinations are generally NOT indicated more frequently than once per chemotherapy treatment cycle for patients with metastatic solid tumors which express CEA or every two months post-surgical treatment for patients who have had colorectal carcinoma.

o However, it may be proper to order the test more frequently in certain situations, for example:

 When there has been a significant change from prior CEA level.

 A significant change in patient status which could reflect disease progression or recurrence.

• Testing with a diagnosis of an in situ carcinoma is not reasonably done more frequently than once, unless the result is abnormal, in which case the test may be repeated once.

• 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

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Medicare NCD Link