Prostate Cancer Screening - JE Part A

HCPCS/CPT Codes

• G0102 - Digital Rectal Exam (DRE)
• G0103 - Prostate Specific Antigen (PSA) test

Frequency

Annually

Diagnosis Code

Z12.5 - Encounter for screening for malignant neoplasm of prostate

Coverage

Male beneficiaries aged 50 and older

• Coverage begins day after 50th birthday
• G0102 bundled into covered evaluation and management service when furnished on same day

Payment

• G0102 - Copayment/coinsurance applies; Deductible applies
• G0103 - Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0103

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 50
• CMS Medicare Preventive Services
• CMS National Coverage Determination (NCD) 210.1