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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.

ICD-10Descriptor
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
C79.2 Secondary malignant neoplasm of skin
C79.81 Secondary malignant neoplasm of breast
G89.3 Neoplasm related pain (acute) (chronic)
R97.8 Other abnormal tumor markers
Z85.3 Personal history of malignant neoplasm of breast

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