Cystatin C Measurement

Cystatin C measurement is covered for adults when used to confirm serum creatinine–based eGFR of 45–59 ml/min/1.73 m2 (CKD stage 3A) without markers of kidney damage, or when creatinine-based eGFR is thought inaccurate (e.g., abnormal muscle mass, diet, interfering medications) or when clinical decisions require a more precise GFR (CKD confirmation, kidney donor evaluation, renal drug dosing). Testing to assess cardiovascular risk is investigational and excluded from coverage, and cystatin C testing is not considered medically necessary for CKD stages 1, 2, 3B, 4, or 5. Repetitive testing without documented medical necessity will be denied and claims must include supporting medical record justification.

"Cystatin C testing is medically reasonable and necessary in adults with serum creatinine–based eGFR 45–59 ml/min/1."

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