Coding Analysis for Labs (CAL) Tracking Sheet

Tumor Antigen Immunoassay CA 125 (Revision to Include Additional Personal History of Malignancy Codes)

CAG-00245N

Issue

[Coding determinations made as part of the Coding Analysis for Laboratory (CAL) process do not constitute National Coverage Determinations (NCDs), but only serve to provide clarification on codes that are covered under a particular laboratory negotiated NCD.]

The current national coverage determination (NCD) for tumor antigen immunoassay CA 125 includes the indication of surveillance following completion of chemotherapy as an index of residual disease in patients with ovarian, fallopian tube endometrium and endocervical carcinoma. It has been brought to our attention that the list of covered diagnoses for this test does not include ICD-9-CM codes V10.41 and V10.42 (Personal history of malignant neoplasm cervix uteri and other part of uterus). We will be reviewing these codes more carefully with the benefit of public comment to make a determination if they should be added to the list of covered diagnoses.

Benefit Category

Diagnostic Laboratory Tests

Requestor Information

Requestor Name Requestor Letter
Internally generated N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
06/24/2004
Expected CAL Completion Date
09/24/2004
Public Comment Period
06/24/2004 - 07/24/2004
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
07/27/2004

Contacts

Lead Analysts
Jackie Sheridan-Moore
Lead Medical Officers

Medicare Benefit Category Determination Date

Actions Taken

June 24, 2004

Tracking sheet posted on the Internet.

July 27, 2004

November 26, 2004

Published implementing instructions in transmittal 380 or pub 100-4 (CR3429)