CG-LAB-32 Cancer Antigen 125 Testing

This policy addresses Cancer Antigen 125 (CA-125) tumor marker blood testing. CA-125 is medically necessary when used either for the initial evaluation of suspected or diagnosed disease or to assess for residual tumor after surgery, and only for the following malignancies: appendiceal adenocarcinoma; endometrial cancer; ovarian, primary peritoneal, or fallopian tube cancer; pancreatic adenocarcinoma; peritoneal mesothelioma; and uterine neoplasms (endometrial cancer or uterine sarcoma). It is not medically necessary when these criteria are not met, including use as a screening test in average‑risk individuals.

"CA-125 testing is consideredmedically necessaryforeitherclinical scenario (AorB)andthe following conditions (C):As part of initial evaluation for suspected or diagnosed disease;orTo determine wheth..."

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