CPT® Code 86304 is used to report quantitative measurement of Cancer Antigen 125 (CA 125) using an immunoassay method. CA 125 is a tumor marker most commonly associated with ovarian cancer, and is used to monitor disease progression, treatment response, and recurrence.
This code represents the laboratory assay only, not specimen collection or interpretation services, which may be reported separately when appropriate.
Key Facts About CPT® 86304
- Service type: Laboratory test (oncology marker)
- Test: CA 125 (quantitative immunoassay)
- Specimen type: Serum or plasma
- Test purpose: Monitor ovarian cancer and related conditions
- Provider type: Laboratories, physicians, and qualified healthcare professionals
Common clinical indications:
- Monitoring treatment response in ovarian cancer
- Surveillance for cancer recurrence
- Evaluation of pelvic masses in appropriate clinical contexts
- Follow-up of previously elevated CA 125 levels
- Adjunct to imaging and clinical findings in oncology care
When to Use CPT® 86304
CPT 86304 is appropriate when:
- Measuring CA 125 levels quantitatively
- Monitoring patients with known ovarian cancer
- Tracking treatment response or recurrence
- Evaluating clinically indicated tumor marker levels in conjunction with other findings
Examples:
- Serial CA 125 testing during chemotherapy for ovarian cancer
- Monitoring for recurrence after cancer treatment
- Evaluating a patient with a known pelvic mass and prior CA 125 elevation
- Following trends in CA 125 levels over time
Documentation Requirements
To support CPT 86304 billing, documentation should include:
- Patient identifiers and date of service
- Clinical indication for testing
- Relevant diagnosis or cancer history
- Specimen type (serum or plasma)
- Test performed (CA 125 quantitative immunoassay)
- Test result and date reported
- Ordering provider information
Clear documentation supports medical necessity, especially for serial monitoring.
Reimbursement and Coding Considerations
- CPT 86304 is generally covered when medically necessary, particularly for cancer monitoring
- Not typically recommended as a screening test in asymptomatic patients without risk factors
- Often performed as serial testing, which must be supported by clinical documentation
- Diagnosis coding should reflect malignancy, history of cancer, or relevant clinical findings
- May be subject to payer frequency limitations
Always verify payer-specific oncology testing guidelines.
How OptiMantra Supports Tumor Marker Testing
OptiMantra’s integrated EMR and practice management system streamlines documentation and billing for CPT 86304:
With OptiMantra, providers can:
- Order CA 125 testing within the patient chart
- Track tumor marker trends over time for clinical decision-making
- Link lab results to oncology diagnoses and treatment plans
- Maintain organized laboratory documentation that supports billing compliance and audit preparedness
- Integrate lab monitoring into comprehensive patient care workflows
By centralizing lab and oncology workflows, OptiMantra helps practices improve efficiency, ensure compliance, and optimize reimbursement.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
.png)
