Coding Analysis for Labs (CAL) Tracking Sheet

Tumor Antigen by Immunoassay CA 19-9 (Modification of Code List to Include ICD-9-CM Code 156.2, Malignant neoplasm of Ampulla of Vater)

CAG-00275N

Issue

The current national coverage determination (NCD) for tumor antigen immunoassay CA 19-9 includes the indication of surveillance in following the course of patients with established diagnosis of pancreatic and biliary ductal carcinoma. It has been brought to our attention that the list of covered diagnoses for this test does not include ICD-9-CM codes 156.0, Malignant neoplasm of gallbladder, and 156.2, Malignant neoplasm of the Ampulla of Vater. 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
Debbie Beedlow, Hematology and Oncology Consultants, PA, Orlando, Florida N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
12/22/2004
Expected CAL Completion Date
03/23/2005
Public Comment Period
12/22/2004 - 01/21/2005
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
03/11/2005

Contacts

Lead Analysts
Jackie Sheridan-Moore
Lead Medical Officers
James Rollins, MD

Medicare Benefit Category Determination Date

Actions Taken

December 22, 2004

Posted notice of CAL to Internet for public comments

March 11, 2005

Posted decision memorandum to Internet.