Prepare for an Uptick in Prostate Cancer Screening Claims

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  • September 7, 2016
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Prepare for an Uptick in Prostate Cancer Screening Claims

September is Prostate Cancer Awareness month.
Prostate cancer is the most common cancer among American men, other than skin cancer. The prostate is a part of the male reproductive system, which produces fluid that makes up a part of semen. It is located just below the bladder and in front of the rectum.
Because the risk for prostate cancer increases with age, all male Medicare beneficiaries 50 years and older are covered for annual prostate cancer screening.

Prevention is the Best Medicine

There are two common preventive screening tests for prostate cancer:

  • Digital rectal exam (DRE)
  • Prostate specific antigen (PSA) test

The U.S. Preventive Services Task Force recommends against PSA-based screening for men who do not have symptoms. Only a biopsy can diagnose prostate cancer for certain.

Coding Prostate Cancer Screening

For Medicare patients, report the following HCPCS Level II codes, as appropriate:
G0102 Prostate cancer screening; digital rectal exam
G0103 Prostate cancer screening; prostate specific antigen test (PSA)
The ICD-10 diagnosis code to support either screening is:
Z12.5 Encounter for screening for malignant neoplasm of prostate

Billing Prostate Cancer Screening

For a DRE, Medicare Part B copayment/coinsurance and deductible apply. For a PSA, Medicare Part B copayment/coinsurance and deductible are waived.

Medicare Preventive Services Educational Tool
Centers for Disease Control and Prevention

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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