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Oncology & Hematology Coding Alert

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Cash in on CA-125 for PPC Patients

Published on Sun Jan 01, 2006

CMS now covers peritoneum neoplasm diagnosis codes for tumor antigen by immunoassay

CMS announced its decision to cover immunoassay CA-125 for primary peritoneal carcinoma (PPC). Commenters provided sufficient clinical evidence that CA-125 is reasonable and necessary for keeping tabs on patients with PPC.

CMS will add PPC to the indications described in the national coverage determination for tumor antigen by immunoassay CA-125. It will also add ICD-9-CM codes 158.8 (Malignant neoplasm of retroperitoneum and peritoneum; specified parts of peritoneum) and 158.9 (... peritoneum, unspecified) to the list of covered codes associated with the NCD for tumor antigen by immunoassay CA-125.

You can view the decision at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=161.
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