CG-LAB-33 Carcinoembryonic Antigen Testing

This policy addresses carcinoembryonic antigen (CEA) blood testing (CPT 82378). CEA testing is medically necessary when used for initial evaluation of suspected or diagnosed disease or to assess residual tumor post-surgery in: ampullary or appendiceal adenocarcinoma; biliary tract (gallbladder, cholangiocarcinoma); colorectal/rectal and small bowel (duodenum, jejunum, ileum) adenocarcinoma; pancreatic neoplasms; ovarian/primary peritoneal/fallopian tube cancer; malignant pleural mesothelioma; medullary thyroid carcinoma; metastatic breast cancer; and Multiple Endocrine Neoplasia type 2 (MEN2). It is not medically necessary when these criteria are not met, including use as a screening test in average-risk individuals.

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