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Full Answer
Does Medicare cover CA-125 testing for PPC?
Medicare currently covers the use CA-125 for monitoring of response to therapy related to ovarian cancer. Based on this strong association between these two conditions, we believe that CA-125 testing is reasonable and necessary for monitoring response to therapy for PPC.
What is the CPT code for CA 125?
CA 125 National Coverage Determination. CPT Code: 86304 .
How often do you check ca 125 levels?
The CA 125 levels are again obtained at the completion of chemotherapy as an index of residual disease. Surveillance CA125 measurements are generally obtained every 3 months for 2 years, every 6 months for the next 3 years, and yearly thereafter.
What is the relationship between CA-125 levels and response to therapy?
Other authors have found that CA-125 levels correlate with the clinical status of the disease and response to therapy (Killackey, Davis, 1993; Mills Anderson, Fechner, 1988).
Does Medicare pay for a CA-125 blood test?
Medicare currently covers the use CA-125 for monitoring of response to therapy related to ovarian cancer. Based on this strong association between these two conditions, we believe that CA-125 testing is reasonable and necessary for monitoring response to therapy for PPC.
What ICD 10 code will cover CA-125?
Elevated cancer antigen 125 [CA 125] R97. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM R97. 1 became effective on October 1, 2021.
How much does a c125 blood test cost?
A CA-125 blood test can cost $200 or more. An ultrasound costs $150 to $250. And surgery costs a lot more, especially if there are complications. For women who want both ovaries removed, there may be added costs for hormone therapy that may be used for many years depending on the individual's age and symptoms.
What diagnosis covers CA-125?
CA-125 is an accepted tool for monitoring patients with known ovarian cancer and other gynecologic malignancies. It has been proposed for use as a screening test in asymptomatic women. CA-125 is a high-molecular-weight protein antigen that is commonly elevated in patients with known ovarian cancer.
How long does it take to process a CA 125?
Your blood test will be sent to the lab. It will take up to 24 – 48 hours for the results to be ready.
Is CA 125 a diagnostic test?
It shows that CA125 is being widely used as a diagnostic tool throughout the medical specialities for a whole range of signs and symptoms, and is not restricted to patients presenting with the classic picture of ovarian cancer.
How do I get a CA-125 test?
For a CA 125 test, a member of your health care team takes a sample of blood by inserting a needle into a vein, usually in the hand or arm. The blood sample is sent to a lab for analysis. You can return to your usual activities immediately.
Does CA-125 blood test detect all cancers?
No, a high CA-125 does not always mean cancer is present. Generally speaking, the normal range of CA-125 is considered to be 0-35 units/mL, while a level above 35 units/mL is considered to be a high CA-125 level.
Who can order a CA-125 blood test?
In some cases, a healthcare practitioner may order a CA-125 test when you have a pelvic mass in order to help determine the cause. Some healthcare providers may order a CA-125 test and a transvaginal ultrasound at regular intervals when you are at high risk of developing ovarian cancer.
Can stress cause CA125 to rise?
There is also some evidence to suggest that stress may cause your body to generate increased CA-125. If you're experiencing any of the above health conditions, including high levels of stress, tell your doctor before having your test done.
Is CA 125 a tumor marker?
Cancer antigen 125 (CA 125) is the only tumor marker recommended for clinical use in the diagnosis and management of ovarian cancer.
Can ovarian cysts raise CA125 levels?
Elevated CA-125 (a protein in the blood that's associated with ovarian cancer) is most often caused by common, ordinary or benign conditions such as uterine fibroids, ovarian cysts, endometriosis — or even just having your period.
Description Information
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
National Coverage Analyses (NCAs)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
Decision Summary
The Centers for Medicare and Medicaid Services (CMS) has determined that there is sufficient evidence to conclude that CA-125 testing is reasonable and necessary for the surveillance of Primary Peritoneal Carcinoma (PPC) in Medicare beneficiaries following treatment. We will add PPC to the indications described in the narrative NCD for tumor antigen by immunoassay CA-125.
Decision Memo
The Centers for Medicare and Medicaid Services (CMS) has determined that there is sufficient evidence to conclude that CA-125 testing is reasonable and necessary for the surveillance of Primary Peritoneal Carcinoma (PPC) in Medicare beneficiaries following treatment.
Bibliography
Eltabbakh GH, Piver MS, Natarajan N, Mettlin CJ. Epidemiologic differences between women with extraovarian primary peritoneal carcinoma and women with epithelial ovarian cancer. Obstetrics & Gynecology 1998;91:254-259.
I. Decision
- The Centers for Medicare and Medicaid Services (CMS) has determined that there is sufficient evidence to conclude that CA-125 testing is reasonable and necessary for the surveillance of Primary Peritoneal Carcinoma (PPC) in Medicare beneficiaries following treatment. We will add PPC to the indications described in the narrative NCD for tumor antige...
II. Background
- Epidemiology Primary Peritoneal Carcinoma (PPC) is also referred to as Primary Peritoneal Adenocarcinoma. Terms which are synonymous with PPC include the following: 1. Extraovarian peritoneal serous papillary carcinoma 2. Serous surface papillary carcinoma 3. Multiple focal extraovarian serous carcinoma 4. Primary peritoneal papillary serous adenocarcinoma 5. Serou…
III. History of Medicare Coverage
- Medicare is a defined benefit program. An item or service must fall within a benefit category as a prerequisite to Medicare coverage and not otherwise be excluded from coverage. § 1812 (Scope of Part A); § 1832 (Scope of Part B) § 1861(s) (Definition of Medical and Other Health Services). The current NCD (portions of which are currently found in the National Coverage Determination …
v. FDA Status
- The FDA has approved many CA-125 assays, (Test, Epithelial Ovarian Tumor-Associated Antigen (CA125), Tumor-associated antigen immunological test system, Product Code LTK) by multiple manufacturers. These can be found on the FDA website at URL http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfivd/index.cfm .
VI. General Methodological Principles
- Generally, when making national coverage determinations, CMS evaluates relevant clinical evidence to determine whether or not the evidence is of sufficient quality to support a finding that an item or service falling within a benefit category is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. The …
VII. Evidence
- We are providing a summary of the evidence we considered during our review. The Evidence Table is provided as Appendix A. The principal outcome of interest in assessing the utility of a diagnostic test is its ability to improve health outcomes of persons who are tested. It can be difficult to conclusively prove that changes in ultimate outcomes such as mortality are the resul…
VIII. CMS Analysis
- National coverage determinations (NCDs) are determinations by the Secretary with respect to whether or not a particular item or service is covered nationally under title XVIII of the Social Security Act § 1869(f)(1)(B). In order to be covered by Medicare, an item or service must fall within one or more benefit categories contained within Part A or Part B, and must not be otherwi…
IX. Conclusion
- The Centers for Medicare and Medicaid Services (CMS) has determined that there is sufficient evidence to conclude that CA-125 testing is reasonable and necessary for the surveillance of Primary Peritoneal Carcinoma (PPC) in Medicare beneficiaries following treatment. We will add PPC to the indications described in the narrative NCD for tumor antigen by immunoassay CA-12…