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CMS Transmittals




National Coverage Determination
Procedure Code: 8XXXX
Tumor Antigen by Immunoassay CA 15-3/CA 27.29
CMS Policy Number: 190.29
Back to NCD List

Description: Immunoassay determinations of the serum levels of certain proteins or carbohydrates serve as tumor markers. When elevated, serum concentration of markers may reflect tumor size & grade. This policy specifically addresses the following tumor antigens: CA 15-3 and CA 27.29

Indications:
Multiple tumor markers are available for monitoring the response of certain malignancies to therapy and assessing whether a residual tumor exists post-surgical therapy. CA 15-3 is often medically necessary to aid in the management of patients with breast cancer. Serial testing must be used in conjunction with other clinical methods for monitoring breast cancer. 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. 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.



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

Covered ICD-10 Codes.

C44.1321Sebaceous cell carcinoma skin/ r upper eyelid, inc canthus
C44.1322Sebaceous cell carcinoma skin/ right low eyelid, inc canthus
C44.1391Sebaceous cell carcinoma skin/ left upr eyelid, inc canthus
C44.1392Sebaceous cell carcinoma skin/ left low eyelid, inc canthus
C50.011Malignant neoplasm of nipple and areola, right female breast
C50.012Malignant neoplasm of nipple and areola, left female breast
C50.019Malignant neoplasm of nipple and areola, unsp female breast
C50.021Malignant neoplasm of nipple and areola, right male breast
C50.022Malignant neoplasm of nipple and areola, left male breast
C50.029Malignant neoplasm of nipple and areola, unsp male breast
.... and many more.


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