Carcinoembryonic Antigen Form

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Carcinoembryonic Antigen

Notes: Please refer to the respective Covered Code Lists for additional guidance on coverage.

Indications

(307481) Is the CEA test being considered for follow-up of the patient with colorectal carcinoma at treatment decision-making points? 
(307482) Is the patient presenting with adenocarcinoma of the lung, small cell carcinoma of the lung, or some gastrointestinal carcinomas where a more specific marker is not expressed by the tumor? 
(307483) Is the CEA test ordered preoperatively to aid in determining the post-operative adequacy of surgical resection and subsequent medical management? 
(307484) Is the patient with colorectal carcinoma in the post-operative period and resection of liver metastasis would be indicated, requiring CEA testing every two to three months if they have initial stage II or stage III disease? 
(307485) Is the CEA test being used to assess the tumor's response to therapy at the start of treatment and with subsequent treatment cycles for a patient with metastatic solid tumors which express CEA? 

YesNoN/A
YesNoN/A
YesNoN/A

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Effective Date

11/25/2002

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

CEA is a protein polysaccharide found in some carcinomas. It is effective as a biochemical marker for monitoring the response of certain malignancies to therapy.

Covered Code Lists (including narrative)

July 2023 (PDF) (ICD-10)
April 2023 (PDF) (ICD-10)
January 2023 (PDF) (ICD-10)
October 2022 (PDF) (ICD-10)
July 2022 (PDF) (ICD-10)
April 2022 (PDF) (ICD-10)
January 2022 (PDF) (ICD-10)
October 2021 (PDF) (ICD-10)
July 2021 (PDF) (ICD-10)
April 2021 (PDF) (ICD-10)
January 2021 (PDF) (ICD-10)
October 2020 (PDF) (ICD-10)
July 2020 (PDF) (ICD-10)
April 2020 (PDF) (ICD-10)
January 2020 (PDF) (ICD-10)
October 2019 (PDF) (ICD-10)
July 2019 (PDF) (ICD-10)
April 2019 (PDF) (ICD-10)
January 2019 (PDF) (ICD-10)
October 2018 (PDF) (ICD-10)
July 2018 (PDF) (ICD-10)
April 2018 (PDF) (ICD-10)
January 2018 (ICD-10)
October 2017 (ICD-10)
July 2017 (ICD-10)
April 2017 (ICD-10)
January 2017 (ICD-10)
October 2016 (ICD-10)
January 2016 (ICD-10)
October 2015 (ICD-10, ICD-9)
October 2014 (ICD-10, ICD-9)

Changes to Lab NCD Edit Software

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January 2023
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October 2021
July 2021
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April 2020
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October 2014

Indications

CEA may be medically necessary for follow-up of patients with colorectal carcinoma. It would however only be medically necessary at treatment decision-making points. In some clinical situations (e.g. adenocarcinoma of the lung, small cell carcinoma of the lung, and some gastrointestinal carcinomas) when a more specific marker is not expressed by the tumor, CEA may be a medically necessary alternative marker for monitoring. Preoperative CEA may also be helpful in determining the post-operative adequacy of surgical resection and subsequent medical management. In general, a single tumor marker will suffice in following patients with colorectal carcinoma or other malignancies that express such tumor markers.

In following patients who have had treatment for colorectal carcinoma, ASCO guideline suggests that if resection of liver metastasis would be indicated, it is recommended that post-operative CEA testing be performed every two to three months in patients with initial stage II or stage III disease for at least two years after diagnosis.

For patients with metastatic solid tumors which express CEA, CEA may be measured at the start of the treatment and with subsequent treatment cycles to assess the tumor's response to therapy.

Limitations

Serum CEA determinations are generally not indicated more frequently than once per chemotherapy treatment cycle for patients with metastatic solid tumors which express CEA or every two months post-surgical treatment for patients who have had colorectal carcinoma. However, it may be proper to order the test more frequently in certain situations, for example, when there has been a significant change from prior CEA level or a significant change in patient status which could reflect disease progression or recurrence.

Testing with a diagnosis of an in situ carcinoma is not reasonably done more frequently than once, unless the result is abnormal, in which case the test may be repeated once.

Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).

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