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January 2024
October 2023

CMS Transmittals

National Coverage Determination
Procedure Code: 8XXXX
CMS Policy Number: 190.25
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Description: Alpha-fetoprotein (AFP) is a polysaccharide found in some carcinomas. It is effective as a biochemical marker for monitoring the response of certain malignancies to therapy.

AFP is useful for the diagnosis of hepatocellular carcinoma in high-risk patients (such as alcoholic cirrhosis, cirrhosis of viral etiology, hemochromatosis, and alpha 1-antitrypsin deficiency) and in separating patients with benign hepatocellular neoplasms or metastases from those with hepatocellular carcinoma and, as a non-specific tumor associated antigen, serves in marking germ cell neoplasms of the testis, ovary, retro peritoneum, and mediastinum.

To review all requirements of this policy, please see: CMS NCD listing by Chapter

Covered ICD-10 Codes.

A52.74Syphilis of liver and other viscera
B18.0Chronic viral hepatitis B with delta-agent
B18.1Chronic viral hepatitis B without delta-agent
B18.2Chronic viral hepatitis C
C22.0Liver cell carcinoma
C22.1Intrahepatic bile duct carcinoma
C22.3Angiosarcoma of liver
.... and many more.

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