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ICD-10-CM R97.8, Other abnormal tumor markers | No Prior Auth

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`R97.8`, Other abnormal tumor markers

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.

Key Coverage Criteria

Evaluation of germ cell tumors;or
Testicular cancer or suspicious testicular mass;or
Ovarian cancer;or
Pelvic mass;or
Mediastinal mass;or
Retroperitoneal mass;or

5 Active Policies

ANTHEM-CG-LAB-27, Human Chorionic Gonadotropin Testing

ANTHEM-CG-LAB-26, Outpatient Alpha-Fetoprotein Testing

ANTHEM-CG-LAB-35, Cancer Antigen 19-9 Testing

ANTHEM-CG-LAB-32, Cancer Antigen 125 Testing

A56421, Billing and Coding: CT of the Abdomen and Pelvis

Related Codes

C48.0(5 policies)C56.1(5 policies)C79.63(5 policies)C48.8(5 policies)C79.60(4 policies)C56.9(4 policies)C78.6(4 policies)C79.82(4 policies)

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