Date Issued: 7/19/2018
Effective October 30, 2018, EmblemHealth will apply its existing tumor antigen by immunoassay policy to GHI plans. Aligned with a Centers for Medicare & Medicaid Services (CMS) policy, tumor antigen by immunoassay CA 15-3/CA 27.29 (86300) is payable when billed with specific diagnoses (ICD-10-CM codes (C50.011 - C50.929, C79.2, C79.81, G89.3, R97.8, Z85.3)).
CPT 86300 will be denied in the absence of one of the covered diagnoses identified in the National Coverage Determinations (NCD) coding manual.
| NCD coding manual | Download (PDF) |