# Medicare NCD 190.28: CA 125 tumour marker test

Source: https://onco.cc/terms/medicare-ncd-190-28/  
OnCo record `medicare-ncd-190-28` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Medicare pays for the CA 125 blood test to follow ovarian and related cancers after diagnosis, to check for recurrence and response to treatment, but not to diagnose a pelvic mass or to investigate symptoms.

## Summary

United States, Medicare laboratory National Coverage Determination 190.28, version 2, effective 1 January 2006. The NCD describes CA 125 as "elevated in 80% of patients who present with epithelial ovarian carcinoma" and also in carcinomas of the fallopian tube, endometrium and endocervix, malignant mesothelioma and primary peritoneal carcinoma. Covered uses include a baseline before surgery for a suspicious pelvic mass, three levels in the first month after treatment to estimate the CA 125 half-life, a level at the end of chemotherapy, surveillance (the NCD states measurements "are generally obtained every 3 months for 2 years, every 6 months for the next 3 years, and yearly thereafter") and levels before each cycle in advanced or recurrent disease.

Limitations: not covered "for the evaluation of patients with signs or symptoms suggestive of malignancy", and "specifically not covered for aiding in the differential diagnosis of patients with a pelvic mass as the sensitivity and specificity of the test is not sufficient". CMS publishes quarterly lists of covered diagnosis codes for it; the latest listed is October 2026.

## Fields

- Kind: Term
- Last checked: 2026-11-04
- Also known as: NCD 190.28; Tumor Antigen by Immunoassay - CA 125; Medicare CA-125 coverage
- Tags: us

## Sources

- CMS Medicare Coverage Database: the NCD: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=130&ncdver=2
- CMS Coverage API: the NCD text as data: https://api.coverage.cms.gov/v1/data/ncd?ncdid=130&ncdver=2

## Connected records

- cancers: [Endometrial cancer](https://onco.cc/cancers/endometrial/), [Mesothelioma](https://onco.cc/cancers/mesothelioma/), [Ovarian cancer](https://onco.cc/cancers/ovarian/)
- institutions: [Centers for Medicare & Medicaid Services (CMS)](https://onco.cc/institutions/cms/)
- terms: [CA-125](https://onco.cc/terms/ca-125/)

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