Serum Tumor Markers for Malignancies
Defines reimbursement criteria for measurement of serum tumor biomarkers for cancer workup, monitoring, surveillance, and certain specific indications; applies to providers submitting claims to Blue Cross and Blue Shield of New Mexico.
Added new CPT/HCPCS codes 0558U and 0559U effective 7/1/2025, and 0599U effective 10/1/2025.
Removed code 83615 from the policy's code list.
Reorganized reimbursement information into a table format by marker and updated many marker-specific indications (e.g., expanded monitoring/follow-up indications for multiple ovarian tumor types).
Updated frequency of surveillance for several markers (example: CA-125, AFP, beta-HCG, inhibin, LDH) for borderline ovarian epithelial tumors from every 3-6 months to every visit if initially elevated.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.