September is Prostate Cancer Awareness Month

Prostate cancer is the most common nonskin cancer among men in the United States. It is a disease that in which malignant cancer cells form in the tissues of the prostate. Prostate cancer is treatable and has a very strong possibility of cure if it is caught early. Therefore, Congress added coverage of Prostate Cancer Screening to the Medicare program.

Section 4103 of the Balanced Budget Act of 1997 provides for coverage of prostate cancer screening via the following procedures:

  • Screening digital rectal examination (G0102); and
  • Screening prostate specific antigen blood test (G0103).

Screening digital rectal examination is covered once every 12 months for men who are 50 years of age and older. This test must be performed by a doctor of medicine, or osteopathy, physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse midwife as indicated by State law may perform the examination. Reminder: The screening digital rectal examination is not allowable on the same day as an E/M service.

Screening prostate specific antigen tests are covered once every 12 months as well for men who are 50 years of age and older. This test must be ordered by the beneficiary's attending physician that is fully knowledgeable about the beneficiary's medical condition and will be responsible for using the results in the overall management of the beneficiary's specific medical condition.

September is a good time with this focus to speak to your patients, remind them of the concern of prostate cancer, and recommend that they pursue this annual screening service to help them to identify a potential health issue. Early detection leads to more effective treatment and better recovery.

For more information:

CMS Preventive Services Provider Resources web page - provides preventive services resources.

Preventive Services Quick Reference Chart - A quick reference guide outlining all the preventive services available. Billing guide, frequency and questions and answers.


            Last Updated Tue, 18 Feb 2020 12:51:41 +0000