Lab: Cystatin C Measurement

Cystatin C measurement is covered for adults when used to confirm 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 suspected to be inaccurate and a more precise GFR estimate is needed to guide clinical decisions (e.g., CKD confirmation, donor evaluation, drug dosing). Testing to assess cardiovascular risk is investigational and not covered, and cystatin C testing is considered not medically necessary for CKD stages 1, 2, 3B, 4, and 5. Documentation should include the creatinine eGFR value, absence of kidney damage, and clinical rationale that test results will affect management.

"Adults with serum creatinine–based eGFR 45–59 ml/min/1."

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