All PlansCoverageMedium impact
CA-125
Blue Cross & Blue Shield of Mississippi·MS · OB-GYN, Oncology, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This CA-125 tumor marker policy defines when the test is considered medically necessary (patients with symptoms suggestive of ovarian cancer or known ovarian/gynecologic malignancies) versus investigational (asymptomatic screening). The policy removes ICD-9 diagnosis codes and maintains current coverage criteria.
Action Required
Immediately: Review current CA-125 test orders to ensure appropriate diagnosis codes are used. Only bill CPT 86304 for patients with symptoms suggestive of ovarian cancer or known gynecologic malignancies. Do not bill for asymptomatic screening as it will be denied as investigational. Update billing system with approved ICD-10 diagnosis codes and remove any remaining ICD-9 codes.