Posted on September 12th, 2025.

Ovarian cancer remains one of the most challenging gynecologic malignancies to detect early. As awareness grows and screening protocols evolve, healthcare providers must stay informed not only about clinical guidelines but also about the coding and billing best practices that ensure accurate reimbursement and regulatory compliance.

Ovarian cancer is often diagnosed at an advanced stage due to its subtle symptoms and lack of routine screening. While no universal screening test exists, transvaginal ultrasound (TVUS) and CA-125 blood tests are commonly used for high-risk populations. These tools, when used appropriately, can aid in early detection and improve patient outcomes.

Accurate coding is essential for proper billing and reimbursement. Here are key CPT codes associated with ovarian cancer screening:

• CPT 76830 – Transvaginal ultrasound
• CPT 86304 – CA-125 tumor marker assay
• CPT 99213/99214 – Office visits (when screening is discussed or performed)

Tip: Always document medical necessity, especially when screening asymptomatic patients or those without a family history.

Pairing CPT codes with the correct ICD-10 diagnosis codes is crucial. Commonly used codes include:

• Z12.39 – Encounter for screening for malignant neoplasm of other genital organs
• Z80.41 – Family history of ovarian cancer
• R97.2 – Elevated CA-125

Ensure that documentation clearly supports the use of these codes to avoid denials.

To optimize reimbursement and reduce audit risk:

• Verify payer policies: Not all insurers cover ovarian cancer screening for asymptomatic patients.
• Use modifiers when necessary: For example, modifier -25 may be needed when a significant, separately identifiable E/M service is provided.
• Educate staff: Front-desk and billing teams should understand the nuances of coding for preventive vs. diagnostic services.
• Upcoding office visits without proper documentation
• Missing modifiers that justify multiple procedures
• Incorrect ICD-10 pairings that lead to claim rejections

At Medical Aesthetic Solutions, we specialize in medical billing services, coding audits, and compliance consulting for OB/GYN practices and women's health providers. Our team ensures your practice stays ahead of payer requirements while maximizing revenue.

Ensure your ovarian cancer screening services are coded correctly and reimbursed fully. Explore our Medical Coding Services to streamline your workflow, reduce denials, and stay compliant with evolving payer guidelines. Let Medical Aesthetic Solutions be your trusted partner in healthcare financial management.