Serum Tumor Markers for Malignancies
BCBSNM clinical payment and coding policy describing reimbursement criteria for specific serum tumor markers for diagnostic evaluation, monitoring, staging, and surveillance across a range of malignancies; applies to providers submitting claims to Blue Cross Blue Shield of New Mexico.
Reorganized reimbursement information to focus on the cancer then appropriate biomarkers and removed multiple specific marker/cancer pairings (CEA, inhibin, calcitonin) from reimbursable indications; remainder revised for clarity.
Removed statement that urokinase plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (PAI-1) as serum tumor markers is not reimbursable.
Document updated with literature review and references revised.
Policy created as new policy on 11/1/2022.
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