Prostate Cancer Awareness and Screening

Published 10/10/2023

Now is the time for Prostate Cancer Awareness, focusing on increasing awareness about this chronic disease. 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. 

According to the Centers for Medicare & Medicaid Services (CMS), the prostate gland is part of the male reproductive system that produces fluid that forms part of semen. The prostate is located just below the bladder and in front of the rectum. It is about the size of a walnut. Cancer is a disease in which cells in the body grow out of control and crowd out healthy cells, making it difficult for the body to function normally. Prostate cancer develops when cells in the prostate grow out of control. Risk factors for prostate cancer include increasing age and having a family history of prostate cancer. Some symptoms for prostate cancer include difficulty urinating, frequent urination, pain in back, hips, or pelvis, and blood in urine or semen. However, not all men experience symptoms from prostate cancer.

Prostate cancer is the most common cancer diagnosed in North American men, excluding skin cancers. It is estimated that in 2023, approximately 288,300 new cases and 34,700 prostate cancer–related deaths will occur in the United States. Prostate cancer is now the second-leading cause of cancer death in men, exceeded by lung cancer. It accounts for 29 percent of all male cancers and 11 percent of male cancer-related deaths.

All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about two to three men will die from prostate cancer.

The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer. African-American men or men who have a family history of prostate cancer, are at even more of an increased risk for receiving a prostate cancer diagnosis.

Prostate Cancer Screening (NCD 210.1)

HCPCS and CPT® Codes

What’s Changed?

  • No changes from the last quarter

G0102 — Prostate cancer screening; digital rectal examination
G0103 — Prostate cancer screening; prostate specific antigen test (PSA)  
0359U — Oncology (prostate cancer), analysis of all prostate-specific antigen (PSA) structural isoforms by phase separation and immunoassay, plasma, algorithm reports risk of cancer

ICD-10 Codes: Z12.5

Note: Additional ICD-10 codes may apply. Find individual change requests and specific ICD-10-CM service codes we cover on the CMS ICD-10 webpage. See Palmettogba.com for more information.

Medicare Covers male patients aged 50 and older with Medicare Part B (coverage begins the day after their 50th birthday).

Frequency: Annually

Note: See FAQ on Medicare Preventive Services

Patient Pays 
G0102: — Copayment or coinsurance and deductible apply.      
G0103: — No copayment, coinsurance, or deductible.

Resources:


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