Summary
CA-125 measurement may be considered medically necessary in patients with symptoms suggestive of ovarian cancer or with known ovarian cancer. It may also be considered medically necessary for individual patients with other gynecologic malignancies, such as endometrial cancer, in whom baseline CA-125 levels have been shown to be elevated. Measurement of CA-125 is considered investigational in asymptomatic patients as a screening technique for ovarian cancer.
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What to do
Action · 4 steps
01Billing team: Bill CPT 86304 (immunoassay for tumor antigen, quantitative, CA 125) for patients with symptoms suggestive of ovarian cancer or with known ovarian cancer.
02Billing team: For other gynecologic malignancies, such as endometrial cancer, bill only when baseline CA-125 levels have been shown to be elevated in that patient.
03Billing team: Screening of asymptomatic patients with CA-125 for ovarian cancer is considered investigational under this policy.
04Billing team: Use ICD-10 codes from the Covered Codes list, such as R97.1 (elevated cancer antigen 125) and C56.1 - C56.9 (malignant neoplasm of ovary).
Codes mentioned
86304C56.1C56.9C79.60C79.63R97.1R97.8G89.3N83.00N83.299
Original notice
CA-125
bcbsms.com · Always check the source before changing claims.
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