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PLA Codes

Laboratory Fee Schedule

2019
2018

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2019
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CMS Transmittals



National Coverage Determination
Procedure Code: G0103
Prostate Cancer Screening Tests
CMS Policy Number: 210.1

See also: Medicare Preventive Services

Back to NCD List

Frequency Limitations: Screening prostate specific antigen tests (PSA) are covered at a frequency of once every 12 months for men who have attained age 50. The test must be ordered by a beneficiary's attending physician, physician assistant, nurse practitioner, or clinical nurse specialist who is fully knowledgeable about the beneficiary's medical condition, and who would be responsible for using the results of the test in the overall management of the beneficiary's specific medical problem.



To review all requirements of this policy, please see: CMS NCD listing by Chapter

Covered ICD-10 Codes.

ICD-10Descriptor
Z12.5 Encounter for screening for malignant neoplasm of prostate

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