Lab: Bladder/Urothelial Tumor Markers

Covered: BTA (BTA stat/TRAK), NMP‑22 (including BladderChek), ImmunoCyt, and UroVysion (FISH) are allowed as adjuncts to cystoscopy and cytology for evaluation and surveillance of bladder/urothelial cancer; all other listed bladder tumor marker assays (e.g., BLCA‑1/4, UBC Rapid, telomerase, survivin, etc.) are investigational and not covered. Key requirements: testing must be performed with/after appropriate cystoscopy/cytology and not used for routine asymptomatic screening or before other hematuria workup, is limited by post‑treatment frequency (max 4/yr years 1–2; 3 in year 3; 2 in year 4; 1 annually years 5–15), only one bladder tumor test per date of service is allowed, and documentation must support indications, timing, and any allowed repeat FISH in high‑risk cases.

"Cystoscopy in conjunction with bladder tumor markers is the standard practice to evaluate patients with symptoms suggesting bladder cancer and to monitor treated patients for recurrence or progress..."