CG-LAB-35 Cancer Antigen 19-9 Testing

This policy addresses serum Cancer Antigen 19‑9 (CA 19‑9) testing. It is medically necessary when used either for the initial evaluation of suspected or diagnosed disease or to assess for residual tumor after surgery, and the patient has one of the following: ampullary or appendiceal adenocarcinoma; biliary tract cancers (gallbladder, cholangiocarcinoma); ovarian, primary peritoneal, or fallopian tube cancer; pancreatic adenocarcinoma; or small bowel adenocarcinoma (duodenum, jejunum, ileum). It is not medically necessary when these criteria are not met, including use as a screening test in average-risk individuals.

"CA 19-9 testing is consideredmedically necessaryforeitherclinical scenario (AorB)andthe following conditions (C):As part of initial evaluation for suspected or diagnosed disease;orTo determine whet..."

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