National_Coverage_Determinations_Manual / NCD 406

Why This Topic Matters

National coverage determinations affect whether services may be payable under Medicare and how related laboratory and procedural services are documented and reviewed. Understanding the scope of this policy helps users identify when the article is relevant to coding, medical necessity review, and compliance workflows.

Article Sections

1. 20.25 Cardiac catheterization performed in other than a hospital setting

   This section identifies a repealed coverage entry and includes revision, issuance, effective, and implementation timing information.

2. 190.28 Tumor antigen by immunoassay – CA 125

   This section addresses Medicare coverage guidance for a tumor marker test, including the general clinical context, indications, limitations, and monitoring-related use cases.

3. Indications

   This subsection describes the broad clinical settings in which the test is discussed within the policy.

4. Limitations

   This subsection outlines circumstances where the service is not covered and summarizes the scope of the policy’s restrictions.