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April 2024
January 2024

CMS Transmittals

National Coverage Determination
Procedure Code: 8XXXX
Tumor Antigen by Immunoassay CA 19-9
CMS Policy Number: 190.30
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 these markers may reflect tumor size and grade. This policy specifically addresses the following tumor antigen: CA19-9.

Multiple tumor markers are available for monitoring the response of certain malignancies to therapy and assessing whether residual tumor exists post-surgical therapy.

Levels are useful in following the course of patients with established diagnosis of pancreatic and biliary ductal carcinoma. The test is not indicated for diagnosing these two diseases.

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.

C22.1Intrahepatic bile duct carcinoma
C23Malignant neoplasm of gallbladder
C24.0Malignant neoplasm of extrahepatic bile duct
C24.1Malignant neoplasm of ampulla of Vater
C24.8Malignant neoplasm of overlapping sites of biliary tract
C24.9Malignant neoplasm of biliary tract, unspecified
C25.0Malignant neoplasm of head of pancreas
C25.1Malignant neoplasm of body of pancreas
C25.2Malignant neoplasm of tail of pancreas
C25.3Malignant neoplasm of pancreatic duct
.... and many more.

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