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Prostate Specific Antigen (PSA), a tumor marker for adenocarcinoma of the prostate, can predict residual tumor in the post-operative phase of prostate cancer. Three to six months after radical prostatectomy, PSA is reported to provide a sensitive indicator of persistent disease.
CPT: 84153. CMS National Coverage Policy. Coverage Indications, Limitations, and/or Medical Necessity. Prostate Specific Antigen (PSA), a tumor marker for adenocarcinoma of the prostate, can predict residual tumor in the post-operative phase of prostate cancer.
Billing Coding ICD-10 Medicare and Medicaid. Because prostate cancer is highly curable when detected in the early stages, Medicare (and most commercial payers) covers the cost of annual screening for the disease in male beneficiaries over the age of 50.
Section 4103 of the Balanced Budget Act of 1997 provides for coverage of certain prostate cancer screening tests subject to certain coverage, frequency, and payment limitations. Medicare will cover prostate cancer screening tests/procedures for the early detection of prostate cancer.
Z12.5 is a billable diagnosis code used to specify a medical diagnosis of encounter for screening for malignant neoplasm of prostate. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2024 through September 30, 2025.
ICD-10-CM Codes commonly used for Prostatic Specific Antigen (PSA) Frequency: ANNUAL (12-month) frequency. Sex/Age: Male 50 years of age or older. CODE. Z12.5. DESCRIPTION . Encounter for screening for malignant neoplasm of prostate. Page 1 of 1. Last Updated: December 8, 2023.
It is recommended that males 50 years and older get screened for prostate cancer. Medicare Part B provides coverage for two prostate screening procedures, the Digital Rectal Exam (DRE) and the Prostate specific antigen (PSA) test.
Screening PSA tests are covered at a frequency of once every 12 months for men who have attained age 50 (at least 11 months have passed following the month in which the last Medicare-covered screening PSA test was performed). ICD-10 CODE. DESCRIPTION. Z12.5.
190.31 - Prostate Specific Antigen. Other Names/Abbreviations. Total PSA. Description. Prostate Specific Antigen (PSA), a tumor marker for adenocarcinoma of the prostate, can predict residual tumor in the post-operative phase of prostate cancer.
The ICD-10 diagnosis code to support either screening is Z12.5 Encounter for screening for malignant neoplasm of prostate. There is no deductible or coinsurance/co-payment for the PSA test, but there is for the screening DRE under Medicare Part B.