Coding Analysis for Labs (CAL) Tracking Sheet

Tumor Antigen by Immunoassay CA 125 (Modification of Code List to Include ICD-9-CM Codes for Suspicious Ovarian Mass)

CAG-00284N

Issue

The current national coverage determination (NCD) for tumor antigen immunoassay CA 125 includes the indication of the initial pre-operative work-up for women presenting with a suspicious pelvic mass to be used as a baseline for purposes of post-operative monitoring. A requester has noted that the covered codes include only diagnoses based on histology of the mass (malignancies and neoplasms of uncertain behavior).  He has requested adding diagnoses codes 793.6, Nonspecific abnormal finding on radiological and other examination of abdominal area, including retroperitoneum, and 239.5, Neoplasms of unspecified nature in other genitourinary organs.

He has made a similar request for the NCD for Carcinoembryonic Antigen (CEA) without identifying a provision in the covered indications to support coverage.

We request public comment regarding the addition of one or more of the following ICD-9-CM codes to the NCD for CA 125 and CEA:  793.6, Nonspecific abnormal finding on radiological and other examination of abdominal area, including retroperitoneum, 239.5, Neoplasms of unspecified nature in other genitourinary organs , and 789.39, Abdominal or pelvic swelling, mass or lump of other specified site.

Benefit Category

Diagnostic Laboratory Tests

Requestor Information

Requestor Name Requestor Letter
Jan Elston, MD, Surgical Associates of Zanesville, Inc., Zanesville, OH N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
01/28/2005
Expected CAL Completion Date
04/07/2005
Public Comment Period
01/28/2005 - 02/28/2005
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
03/15/2005

Contacts

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

Medicare Benefit Category Determination Date

Actions Taken

January 28, 2005

Posted notice of CAL to Internet for public comments.

March 15, 2005

Posted decision memo  to the Internet.