OVA1â„¢ is an FDA-cleared qualitative serum test that combines the biomarker values of five immunoassays, using a proprietary algorithm, to further assess the likelihood that an ovarian mass is malignant, in women whose pre-surgical assessment did not indicate malignancy. Highmark Medicare Services will cover OVA1â„¢ in keeping with the FDA-cleared indication until such time that a Local Coverage Determination is developed and implemented. OVA1â„¢ is currently indicated for women who meet the following criteria:

  • Over the age of 18, and
  • Have an ovarian adnexal mass present for which surgery is planned, and
  • Have not been referred to an oncologist, surgical oncologist, or gynecological oncologist.

Until such time that a specific CPT/HCPCS code is issued, the OVA1™ test will be billed to Medicare utilizing the “not otherwise classified” (NOC) CPT code, 84999. When billing an NOC code to Medicare, a brief description of the service must be reported in Block 19 of the CMS 1500 paper claim, or the claims note segment of the electronic claim. “OVA1” will suffice for this brief description. Services billed utilizing an NOC code are individually reviewed and priced accordingly.

Published by XIFIN

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