CodeMap®  150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

PLA Codes

Laboratory Fee Schedule

2019
2018

Physician Fee Schedule

2019
2018

OPPS Fee Schedule

2019
2018

ASC Fee Schedule

2019
2018

APC Codes

2019
2018

DRG Codes

2019
2018

ASP Drug Pricing Files

January 2019
October 2018


CMS Transmittals



National Coverage Determination
Procedure Code: 8XXXX
Carcinoembryonic Antigen
CMS Policy Number: 190.26
Back to NCD List

Description: Carcinoembryonic antigen (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:
CEA may be medically necessary for follow-up of patients with colorectal carcinoma. It would however only be medically necessary at treatment decision-making points. 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. Preoperative CEA may also be helpful in determining the post-operative adequacy of surgical resection and subsequent medical management. 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 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, CEA may be measured at the start of the treatment and 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.

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 or 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.

Frequency 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. It may be proper to order the test more frequently when there has been a significant change from prior CEA level or 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.



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

Covered ICD-10 Codes.

ICD-10Descriptor
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.5 Malignant neoplasm of lesser curvature of stomach, unsp
C16.6 Malignant neoplasm of greater curvature of stomach, unsp
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C17.9 Malignant neoplasm of small intestine, unspecified
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C18.9 Malignant neoplasm of colon, unspecified
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.0 Malignant neoplasm of anus, unspecified
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malig neoplasm of ovrlp sites of rectum, anus and anal canal
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C25.9 Malignant neoplasm of pancreas, unspecified
C26.0 Malignant neoplasm of intestinal tract, part unspecified
C33 Malignant neoplasm of trachea
C34.00 Malignant neoplasm of unspecified main bronchus
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.10 Malignant neoplasm of upper lobe, unsp bronchus or lung
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.30 Malignant neoplasm of lower lobe, unsp bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.80 Malignant neoplasm of ovrlp sites of unsp bronchus and lung
C34.81 Malignant neoplasm of ovrlp sites of right bronchus and lung
C34.82 Malignant neoplasm of ovrlp sites of left bronchus and lung
C34.90 Malignant neoplasm of unsp part of unsp bronchus or lung
C34.91 Malignant neoplasm of unsp part of right bronchus or lung
C34.92 Malignant neoplasm of unsp part of left bronchus or lung
C44.1321 Sebaceous cell carcinoma skin/ r upper eyelid, inc canthus
C44.1322 Sebaceous cell carcinoma skin/ right low eyelid, inc canthus
C44.1391 Sebaceous cell carcinoma skin/ left upr eyelid, inc canthus
C44.1392 Sebaceous cell carcinoma skin/ left low eyelid, inc canthus
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.019 Malignant neoplasm of nipple and areola, unsp female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.029 Malignant neoplasm of nipple and areola, unsp male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.119 Malignant neoplasm of central portion of unsp female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.129 Malignant neoplasm of central portion of unsp male breast
C50.211 Malig neoplm of upper-inner quadrant of right female breast
C50.212 Malig neoplasm of upper-inner quadrant of left female breast
C50.219 Malig neoplasm of upper-inner quadrant of unsp female breast
C50.221 Malig neoplasm of upper-inner quadrant of right male breast
C50.222 Malig neoplasm of upper-inner quadrant of left male breast
C50.229 Malig neoplasm of upper-inner quadrant of unsp male breast
C50.311 Malig neoplm of lower-inner quadrant of right female breast
C50.312 Malig neoplasm of lower-inner quadrant of left female breast
C50.319 Malig neoplasm of lower-inner quadrant of unsp female breast
C50.321 Malig neoplasm of lower-inner quadrant of right male breast
C50.322 Malig neoplasm of lower-inner quadrant of left male breast
C50.329 Malig neoplasm of lower-inner quadrant of unsp male breast
C50.411 Malig neoplm of upper-outer quadrant of right female breast
C50.412 Malig neoplasm of upper-outer quadrant of left female breast
C50.419 Malig neoplasm of upper-outer quadrant of unsp female breast
C50.421 Malig neoplasm of upper-outer quadrant of right male breast
C50.422 Malig neoplasm of upper-outer quadrant of left male breast
C50.429 Malig neoplasm of upper-outer quadrant of unsp male breast
C50.511 Malig neoplm of lower-outer quadrant of right female breast
C50.512 Malig neoplasm of lower-outer quadrant of left female breast
C50.519 Malig neoplasm of lower-outer quadrant of unsp female breast
C50.521 Malig neoplasm of lower-outer quadrant of right male breast
C50.522 Malig neoplasm of lower-outer quadrant of left male breast
C50.529 Malig neoplasm of lower-outer quadrant of unsp male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.619 Malignant neoplasm of axillary tail of unsp female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.629 Malignant neoplasm of axillary tail of unsp male breast
C50.811 Malignant neoplasm of ovrlp sites of right female breast
C50.812 Malignant neoplasm of ovrlp sites of left female breast
C50.819 Malignant neoplasm of ovrlp sites of unsp female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C50.829 Malignant neoplasm of overlapping sites of unsp male breast
C50.911 Malignant neoplasm of unsp site of right female breast
C50.912 Malignant neoplasm of unspecified site of left female breast
C50.919 Malignant neoplasm of unsp site of unspecified female breast
C50.921 Malignant neoplasm of unspecified site of right male breast
C50.922 Malignant neoplasm of unspecified site of left male breast
C50.929 Malignant neoplasm of unsp site of unspecified male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.9 Malignant neoplasm of unspecified ovary
C78.00 Secondary malignant neoplasm of unspecified lung
C78.01 Secondary malignant neoplasm of right lung
C78.02 Secondary malignant neoplasm of left lung
C78.4 Secondary malignant neoplasm of small intestine
C78.5 Secondary malignant neoplasm of large intestine and rectum
C7A.00 Malignant carcinoid tumor of unspecified site
C7A.010 Malignant carcinoid tumor of the duodenum
C7A.011 Malignant carcinoid tumor of the jejunum
C7A.012 Malignant carcinoid tumor of the ileum
C7A.019 Malignant carcinoid tumor of the sm int, unsp portion
C7A.020 Malignant carcinoid tumor of the appendix
C7A.021 Malignant carcinoid tumor of the cecum
C7A.022 Malignant carcinoid tumor of the ascending colon
C7A.023 Malignant carcinoid tumor of the transverse colon
C7A.024 Malignant carcinoid tumor of the descending colon
C7A.025 Malignant carcinoid tumor of the sigmoid colon
C7A.026 Malignant carcinoid tumor of the rectum
C7A.029 Malignant carcinoid tumor of the lg int, unsp portion
C7A.090 Malignant carcinoid tumor of the bronchus and lung
C7A.091 Malignant carcinoid tumor of the thymus
C7A.092 Malignant carcinoid tumor of the stomach
C7A.093 Malignant carcinoid tumor of the kidney
C7A.094 Malignant carcinoid tumor of the foregut, unspecified
C7A.095 Malignant carcinoid tumor of the midgut, unspecified
C7A.096 Malignant carcinoid tumor of the hindgut, unspecified
C7A.098 Malignant carcinoid tumors of other sites
C7B.00 Secondary carcinoid tumors, unspecified site
C7B.01 Secondary carcinoid tumors of distant lymph nodes
C7B.02 Secondary carcinoid tumors of liver
C7B.03 Secondary carcinoid tumors of bone
C7B.04 Secondary carcinoid tumors of peritoneum
C7B.09 Secondary carcinoid tumors of other sites
C7B.1 Secondary Merkel cell carcinoma
C7B.8 Other secondary neuroendocrine tumors
D01.0 Carcinoma in situ of colon
D01.1 Carcinoma in situ of rectosigmoid junction
D01.2 Carcinoma in situ of rectum
D01.40 Carcinoma in situ of unspecified part of intestine
D01.49 Carcinoma in situ of other parts of intestine
D01.7 Carcinoma in situ of other specified digestive organs
D01.9 Carcinoma in situ of digestive organ, unspecified
D37.1 Neoplasm of uncertain behavior of stomach
D37.2 Neoplasm of uncertain behavior of small intestine
D37.3 Neoplasm of uncertain behavior of appendix
D37.4 Neoplasm of uncertain behavior of colon
D37.5 Neoplasm of uncertain behavior of rectum
G89.3 Neoplasm related pain (acute) (chronic)
R70.1 Abnormal plasma viscosity
R77.0 Abnormality of albumin
R77.1 Abnormality of globulin
R77.2 Abnormality of alphafetoprotein
R77.8 Other specified abnormalities of plasma proteins
R77.9 Abnormality of plasma protein, unspecified
R78.89 Finding of oth substances, not normally found in blood
R78.9 Finding of unsp substance, not normally found in blood
R79.89 Other specified abnormal findings of blood chemistry
R97.0 Elevated carcinoembryonic antigen [CEA]
R97.8 Other abnormal tumor markers
Z08 Encntr for follow-up exam after trtmt for malignant neoplasm
Z09 Encntr for f/u exam aft trtmt for cond oth than malig neoplm
Z85.00 Personal history of malignant neoplasm of unsp dgstv org
Z85.038 Personal history of malignant neoplasm of large intestine
Z85.048 Prsnl hx of malig neoplm of rectum, rectosig junct, and anus
Z85.118 Personal history of malignant neoplasm of bronchus and lung
Z85.3 Personal history of malignant neoplasm of breast
Z85.43 Personal history of malignant neoplasm of ovary

The content and format of the following files and/or webpages are copywritten and the property of Wheaton Partners, LLC - dba CodeMap®. All recipients of these files agree not to distribute, reproduce and/or use the information contained within, in any manner not expressly agreed upon by the user and Wheaton Partners, LLC - dba CodeMap®.

All code-pairs and Medicare coverage information are compiled directly from Center for Medicare and Medicaid Services (CMS) and Medicare Contractor coverage policies. CodeMap® has made every reasonable effort to ensure the accuracy of the information contained. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. Both CMS and Medicare contractor coverage policy information may change at any time. CodeMap® makes no representation, warranty, or guarantee that this compilation of coverage policy information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.


CodeMap® is a Registered Trademark of Wheaton Partners, LLC.