{"entity":{"id":"medicare-ncd-190-28","kind":"term","name":"Medicare NCD 190.28: CA 125 tumour marker test","aka":["NCD 190.28","Tumor Antigen by Immunoassay - CA 125","Medicare CA-125 coverage"],"tldr":"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.\n\nLimitations: 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.","asOf":"2026-11-04","links":[{"label":"CMS Medicare Coverage Database: the NCD","url":"https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=130&ncdver=2"},{"label":"CMS Coverage API: the NCD text as data","url":"https://api.coverage.cms.gov/v1/data/ncd?ncdid=130&ncdver=2"}],"tags":["us"],"related":[],"cancers":["ovarian","endometrial","mesothelioma"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["cms"],"pathways":[],"terms":["ca-125"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Regulation & policy"},"route":"/terms/medicare-ncd-190-28/","neighbours":{"cancer":[{"id":"endometrial","kind":"cancer","name":"Endometrial cancer","route":"/cancers/endometrial/"},{"id":"mesothelioma","kind":"cancer","name":"Mesothelioma","route":"/cancers/mesothelioma/"},{"id":"ovarian","kind":"cancer","name":"Ovarian cancer","route":"/cancers/ovarian/"}],"institution":[{"id":"cms","kind":"institution","name":"Centers for Medicare & Medicaid Services (CMS)","route":"/institutions/cms/"}],"term":[{"id":"ca-125","kind":"term","name":"CA-125","route":"/terms/ca-125/"}]}}