Cystatin C Measurement

Cystatin C measurement is covered for adults when used to confirm kidney function in patients with serum creatinine–based eGFR 45–59 ml/min/1.73 m2 (CKD stage 3A) without markers of kidney damage, and when creatinine-based eGFR is suspected to be inaccurate or when clinical decisions (CKD confirmation, donor eligibility, or dosing of renally excreted/toxic drugs) require a more accurate GFR. Testing to assess cardiovascular risk is investigational and not covered, and cystatin C testing is not considered medically necessary for CKD stages 1, 2, 3B, 4, or 5. Some regulatory language regarding Title XVIII coverage and the Stage 5 specification in the source text is ambiguous and flagged for manual review.

"Patient is an adult (age >=18 years)."

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