Key facts for NCD 190.30
- Benefit category
- Diagnostic Laboratory Tests
- Effective date
- 11/25/2002
- Implemented 01/01/2003
- Transmittal
- Transmittal 17
- Versions published
- 1
- Manual chapter
- 190
- NCD Manual (Pub. 100-03)
- Lab edit list
- 28 covered ICD-10
- 245 non-covered
TL;DR
NCD 190.30 sets Medicare's national policy for tumor antigen by immunoassay - ca 19-9 under the benefit category "Diagnostic Laboratory Tests", effective 11/25/2002 and implemented 01/01/2003. Multiple tumor markers are available for monitoring the response of certain malignancies to therapy and assessing whether residual tumor exists post-surgical therapy. As a laboratory NCD it carries a national ICD-10 edit list: 28 diagnosis codes support medical necessity and 245 are denied, applied automatically by every Medicare contractor to 1 procedure code.
Item or service described
Immunoassay determinations of the serum levels of certain proteins or carbohydrates serve as tumor markers. When elevated, serum concentration of these markers may reflect tumor size and grade. This policy specifically addresses the following tumor antigen: CA 19-9.
Indications and limitations of coverage
Indications
Multiple tumor markers are available for monitoring the response of certain malignancies to therapy and assessing whether residual tumor exists post-surgical therapy.
Levels are useful in following the course of patients with established diagnosis of pancreatic and biliary ductal carcinoma. The test is not indicated for diagnosing these two diseases.
Limitations
These services are not covered for the evaluation of patients with signs or symptoms suggestive of malignancy. The service may be ordered at times necessary to assess either the presence of recurrent disease or the patient's response to treatment with subsequent treatment cycles.
Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).
Text reproduced from the CMS Medicare Coverage Database record for NCD 190.30 version 1. View the original on cms.gov.
Laboratory NCD code lists (January 2026)
Medicare contractors apply this NCD through a national edit: the procedure codes below are paid only when the claim carries a covered diagnosis. The January 2026 list holds 28 covered and 245 non-covered ICD-10-CM codes plus 1 codes with other resolution rules.
1 procedure code are edited against this NCD's diagnosis list. CPT codes are shown as numbers only; descriptors are licensed by the AMA.
| Code | Code set |
|---|---|
| 86301 | CPT (descriptor licensed by AMA) |
The first 28 of 28 covered diagnosis codes, with FY2027 ICD-10-CM descriptions. A claim with any covered code on the line supports medical necessity under the national edit.
| ICD-10-CM | Description | Effective |
|---|---|---|
| C221 | Intrahepatic bile duct carcinoma | 2015-10-01 |
| C23 | Malignant neoplasm of gallbladder | 2015-10-01 |
| C240 | Malignant neoplasm of extrahepatic bile duct | 2015-10-01 |
| C241 | Malignant neoplasm of ampulla of Vater | 2015-10-01 |
| C248 | Malignant neoplasm of overlapping sites of biliary tract | 2015-10-01 |
| C249 | Malignant neoplasm of biliary tract, unspecified | 2015-10-01 |
| C250 | Malignant neoplasm of head of pancreas | 2015-10-01 |
| C251 | Malignant neoplasm of body of pancreas | 2015-10-01 |
| C252 | Malignant neoplasm of tail of pancreas | 2015-10-01 |
| C253 | Malignant neoplasm of pancreatic duct | 2015-10-01 |
| C254 | Malignant neoplasm of endocrine pancreas | 2015-10-01 |
| C257 | Malignant neoplasm of other parts of pancreas | 2015-10-01 |
| C258 | Malignant neoplasm of overlapping sites of pancreas | 2015-10-01 |
| C259 | Malignant neoplasm of pancreas, unspecified | 2015-10-01 |
| C787 | Secondary malignant neoplasm of liver and intrahepatic bile duct | 2015-10-01 |
| C7880 | Secondary malignant neoplasm of unspecified digestive organ | 2015-10-01 |
| C7889 | Secondary malignant neoplasm of other digestive organs | 2015-10-01 |
| D376 | Neoplasm of uncertain behavior of liver, gallbladder and bile ducts | 2015-10-01 |
| D378 | Neoplasm of uncertain behavior of other specified digestive organs | 2015-10-01 |
| D379 | Neoplasm of uncertain behavior of digestive organ, unspecified | 2015-10-01 |
| G893 | Neoplasm related pain (acute) (chronic) | 2015-10-01 |
| M3303 | Juvenile dermatomyositis without myopathy | 2017-10-01 |
| M3313 | Other dermatomyositis without myopathy | 2017-10-01 |
| M3393 | Dermatopolymyositis, unspecified without myopathy | 2017-10-01 |
| R978 | Other abnormal tumor markers | 2015-10-01 |
| Z85068 | Personal history of other malignant neoplasm of small intestine | 2015-10-01 |
| Z8507 | Personal history of malignant neoplasm of pancreas | 2015-10-01 |
| Z8509 | Personal history of malignant neoplasm of other digestive organs | 2015-10-01 |
245 diagnosis codes deny automatically under this NCD; the first 20 are shown.
| ICD-10-CM | Description |
|---|---|
| R99 | Ill-defined and unknown cause of mortality |
| Z0000 | Encounter for general adult medical examination without abnormal findings |
| Z0001 | Encounter for general adult medical examination with abnormal findings |
| Z00110 | Health examination for newborn under 8 days old |
| Z00111 | Health examination for newborn 8 to 28 days old |
| Z00121 | Encounter for routine child health examination with abnormal findings |
| Z00129 | Encounter for routine child health examination without abnormal findings |
| Z005 | Encounter for examination of potential donor of organ and tissue |
| Z006 | Encounter for examination for normal comparison and control in clinical research program |
| Z0070 | Encounter for examination for period of delayed growth in childhood without abnormal findings |
| Z0071 | Encounter for examination for period of delayed growth in childhood with abnormal findings |
| Z008 | Encounter for other general examination |
| Z020 | Encounter for examination for admission to educational institution |
| Z021 | Encounter for pre-employment examination |
| Z022 | Encounter for examination for admission to residential institution |
| Z023 | Encounter for examination for recruitment to armed forces |
| Z024 | Encounter for examination for driving license |
| Z025 | Encounter for examination for participation in sport |
| Z026 | Encounter for examination for insurance purposes |
| Z0271 | Encounter for disability determination |
Revision history
07/2004 - Published NCD in the NCD Manual without change to narrative contained in PM AB-02-110. Coding guidance now published in Medicare Lab NCD Manual. Effective and Implementation dates NA. ( TN 17 ) (CR 2130)
07/2002 - Implemented NCD. Effective date 11/25/02. Implementation date 1/01/03. ( TN AB-02-110 ) (CR 2130)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 190.30
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 190.30
What does NCD 190.30 cover?
Multiple tumor markers are available for monitoring the response of certain malignancies to therapy and assessing whether residual tumor exists post-surgical therapy. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 190.30 take effect?
The current version (1) is effective 11/25/2002, implemented 01/01/2003, published in transmittal 17. This is the only published version.
Does a Local Coverage Determination override NCD 190.30?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Which diagnosis codes are covered under NCD 190.30?
The January 2026 laboratory NCD edit list contains 28 ICD-10-CM codes that support tumor antigen by immunoassay - ca 19-9 (for example C221 Intrahepatic bile duct carcinoma; C23 Malignant neoplasm of gallbladder; C240 Malignant neoplasm of extrahepatic bile duct) and 245 codes that deny. The list applies to 86301.
How often does the lab NCD code list for 190.30 change?
CMS updates the laboratory NCD edit module quarterly, with the January release carrying the annual ICD-10-CM code changes. Codes added or deleted mid-year appear in the quarterly change spreadsheets on the Lab NCDs page.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
- Laboratory NCD ICD-10 code lists, January 2026Version January 2026 · effective 2026-01-01 · file 2026100-Initial-ICD10-NCD-Spreadsheet-20250721-508.xlsxSHA-256 57ff5cd37ba523d3…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.