Bladder/Urothelial Tumor Markers - Diagnostic Laboratory Services, Inc.

2021

MEDICARE LOCAL COVERAGE DETERMINATION (LCD) - L36678

Billing and Coding Local Coverage Article A55028

PROCEDURE CODES: 86294, 86316, 86386, 88120, 88121

Lab: Bladder/Urothelial Tumor Markers

For services performed on or after 5-16-2017

For more information on coverage indications, limitations and/or medical necessity,

please view the complete policy on

52989

67369

DLS TEST CODE AND NAME

NEURON SPECIFIC ENOLASE (CSF) (Proc Code: 86316)

CHROMOGRANIN A (Proc Code: 86316)

DESCRIPTION

ICD-10 CODE

C67.0

C67.1

C67.2

C67.3

C67.4

C67.5

C67.6

C67.7

C67.8

C67.9

C7A.010

C7A.011

C7A.012

C7A.020

C7A.021

C7A.022

C7A.023

C7A.024

C7A.025

C7A.026

C7A.090

C7A.091

C7A.092

C7A.093

C7A.098

C7A.8

C7B.01

C7B.02

C7B.03

C7B.04

C7B.09

Malignant neoplasm of trigone of bladder

Malignant neoplasm of dome of bladder

Malignant neoplasm of lateral wall of bladder

Malignant neoplasm of anterior wall of bladder

Malignant neoplasm of posterior wall of bladder

Malignant neoplasm of bladder neck

Malignant neoplasm of ureteric orifice

Malignant neoplasm of urachus

Malignant neoplasm of overlapping sites of bladder

Malignant neoplasm of bladder, unspecified

Malignant carcinoid tumor of the duodenum

Malignant carcinoid tumor of the jejunum

Malignant carcinoid tumor of the ileum

Malignant carcinoid tumor of the appendix

Malignant carcinoid tumor of the cecum

Malignant carcinoid tumor of the ascending colon

Malignant carcinoid tumor of the transverse colon

Malignant carcinoid tumor of the descending colon

Malignant carcinoid tumor of the sigmoid colon

Malignant carcinoid tumor of the rectum

Malignant carcinoid tumor of the bronchus and lung

Malignant carcinoid tumor of the thymus

Malignant carcinoid tumor of the stomach

Malignant carcinoid tumor of the kidney

Malignant carcinoid tumors of other sites

Other malignant neuroendocrine tumors

Secondary carcinoid tumors of distant lymph nodes

Secondary carcinoid tumors of liver

Secondary carcinoid tumors of bone

Secondary carcinoid tumors of peritoneum

Secondary carcinoid tumors of other sites

Source: cms.mcd

Effective Date: 05-16-2017, last updated 2-11-2021

BLADDER URO TUMOR MARKERS

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DESCRIPTION

ICD-10 CODE

C7B.8

D09.0

D41.4

D49.4

E34.0

R31.0

R31.1

R31.21*

Other secondary neuroendocrine tumors

Carcinoma in situ of bladder

Neoplasm of uncertain behavior of bladder

Neoplasm of unspecified behavior of bladder

Carcinoid syndrome

Gross hematuria

Benign essential microscopic hematuria

Asymptomatic microscopic hematuria

*To be used only when repeat testing is believed to be medically reasonable and necessary, and

must be listed as secondary with the primary neoplastic diagnosis.

R31.29*

Other microscopic hematuria

*To be used only when repeat testing is believed to be medically reasonable and necessary, and

must be listed as secondary with the primary neoplastic diagnosis.

Z78.9*

Other specified health status

*To be used only when repeat testing is believed to be medically reasonable and necessary, and

must be listed as secondary with the primary neoplastic diagnosis.

Z85.51

Personal history of malignant neoplasm of bladder

Source: cms.mcd

Effective Date: 05-16-2017, last updated 2-11-2021

BLADDER URO TUMOR MARKERS

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