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Do you get CEA (Carcinoembryonic Antigen) Blood test for lung cancer?

Lung Cancer | Last Active: Apr 23 2:38pm | Replies (15)
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@lls8000

@abob, I agree that he should have been presented with information on the potential for denial. The companies that perform these types of tests are familiar with dealing with denials, so this isn't over yet, and unfortunately denials are common.
When I was first diagnosed, I was obviously stage IV and my husband's insurance still denied the claim. The performing lab contacted me, I signed an authorization to allow them to appeal the denial on my behalf. I never heard from them again. Either it got paid, or the company waived the charge.
Be patient, it may take some time to work out, but hopefully you won't be left with a bill.
(Link to the CMS page with biomarker info: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=372)
In some cases these test results can significantly alter treatment plans. Are his results back yet? Were there any significant findings from the test?

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Replies to "@abob, I agree that he should have been presented with information on the potential for denial...."
abob | @abob | Apr 23 1:46pm

Thx for your helpful reply. Gardant is appealing and our Oncology group is assisting with the appeal.

Gardant published this last year:
https://investors.guardanthealth.com/press-releases/press-releases/2023/Guardant-Health-Receives-Medicare-Coverage-for-Guardant360-Response-to-Monitor-Cancer-Patient-Response-to-Immunotherapy/default.aspx
Local Coverage Determination (LCD)
MolDX: Plasma-Based Genomic Profiling in Solid Tumors: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38043
Criteria for Coverage: Guardant360® is covered only when all of the following conditions are met:
QUITE A DETAILED LIST!

Report showed only 0.091% detectable which is/was great. And happily the more recent CT showed adrenal mass is now undetectable.

( So did the patient really need the 1 snapshot in time Gardant $5K test to be paid for by Medicare or us for his care? Since his cancer specialist is also a research group if done for research purposes, does this raise a payment responsibility issue?)

Nonetheless, oncologist is recommending adrenalectomy due to any pesky remaining chemo specs. Then probably immunotherapy.

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