Appendix E - National Coverage Determinations Manual / TUMOR_ANTIGEN_BY_IMMUNOASSAY

Why This Topic Matters

Coverage policy for tumor marker testing affects whether claims are payable and how laboratory services are documented in oncology care. Understanding the scope of the national determination helps prevent noncovered testing and supports appropriate reporting for monitoring and surveillance scenarios.

Article Sections

1. Tumor Antigen By Immunoassay — CA 125

   Introduces the Medicare coverage topic and identifies the tumor marker addressed by the policy. Provides the effective and implementation context for the determination.

2. Indications

   Summarizes the clinical situations discussed for use of the test, including initial assessment and follow-up contexts. Describes the types of malignancy-related monitoring covered by the policy.

3. Limitations

   Outlines the boundaries of coverage and the types of uses that are not covered under the policy. Addresses situations involving evaluation and diagnostic use.