Prostate cancer may be found by testing the amount of PSA (Prostate Specific Antigen) in your blood. Another way prostate cancer may be found is when your doctor performs a digital rectal exam. Medicare covers both of these tests.

Who Is Covered

All male Medicare beneficiaries aged 50 and older (coverage begins the day after their 50th birthday)

HCPCS/CPT Codes

G0102 - Digital Rectal Exam (DRE)

G0103 - Prostate Specific Antigen Test (PSA)

ICD-10-CM Codes

Z12.5

Frequency

Annually for covered beneficiaries

Medicare Beneficiary Pays

G0102

Digital rectal exam: You pay 20% of the Medicare-approved amount for a yearly digital rectal exam and for the doctor's services related to the exam. The Part B deductible applies. In a hospital outpatient setting, you pay a copayment.

   • Copayment applies

   • Coinsurance applies

   • Deductible applies

G0103

PSA test: You pay nothing for a yearly PSA blood test. If you get the test from a doctor that doesn’t accept assignment, you may have to pay an additional fee for the doctor’s services, but not for the test itself.

   • Copayment waived

   • Coinsurance waived

   • Deductible waived

References