Automated World Health
NCD190.27
HUMAN CHORIONIC GONADOTROPIN
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.
Indications and Limitations of Coverage
Indications
• Human Chorionic Gonadotropin (hCG) is useful for monitoring and diagnosis of germ cell neoplasms of the:
o Ovary.
o Testis.
o Mediastinum.
o Retroperitoneum.
o Central nervous system.
o In addition, hCG is useful for monitoring pregnant patients with:
Vaginal bleeding.
Hypertension.
Suspected fetal loss.
Limitations
• It is not reasonable and necessary to perform hCG testing more than once per month for diagnostic purposes.
o It may be performed as needed for monitoring of patient progress and treatment.
o Qualitative hCG assays are not appropriate for medically managing patients with known or suspected germ cell neoplasms.
• 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
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Changes to Lab NCD Edit Software
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Coding Analyses for Labs (CALs)
• This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.
• Original consideration for Human Chorionic Gonadotropin (Addition of ICD-9-CM Code 158.9, Malignant Neoplasm of Peritoneum, Unspecified) (CAG-00372N)
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