National_Coverage_Determinations_Manual / TUMOR_ANTIGEN_BY_IMMUNOASSAY

Why This Topic Matters

Coverage rules for laboratory tumor marker testing affect whether claims are payable and how documentation should support medical necessity under Medicare policy. Understanding the scope of this NCD helps organizations align ordering, billing, and compliance practices with the published coverage limitations.

Article Sections

1. Tumor Antigen By Immunoassay – CA 125

   Introduces the policy topic, revision information, and the general clinical context for tumor marker testing by immunoassay.

2. Indications

   Summarizes the covered clinical scenarios discussed in the policy, including oncology-related monitoring contexts and associated disease settings.

3. Limitations

   Describes situations addressed by the policy that are not covered and other restrictions on use under the determination.