CMS coverage policies for diagnostic and screening PSAs

As a result of negotiated rule making, an NCD was developed for the diagnostic PSA test. In Program Memo AB-03-132, the CMS instructed local contractors to include a provider education article regarding diagnostic and screening PSA tests in their next regularly scheduled bulletin.

The key points:

• Diagnostic PSA testing is subject to a national Medicare coverage policy which specifies the CPT code covered (84153) as well as the necessary clinical indications and the ICD-9 diagnosis codes recognized as justifying medical necessity.
• Screening PSA testing is covered annually by Medicare for male beneficiaries age 50 and older.
• Use HCPCS code G0103 for the screening PSA test.