What this is, in plain language
A blood test that measures PSA, a protein made by the prostate — used to screen for prostate cancer and monitor known prostate conditions.
Why a clinician orders it
Prostate cancer screening (after discussing risks and benefits), or monitoring an elevated PSA or known prostate condition.
Medical necessity — what insurers usually look at
Screening PSA is covered once a year for men over 50 by Medicare and many plans as preventive care. Diagnostic PSA (for symptoms or monitoring) is covered but may apply cost-sharing differently — ask how it will be billed.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓Whether billed as screening or diagnostic
- ✓In-network lab confirmation
Questions for your provider
- ?Will this be billed as preventive screening or diagnostic?
- ?Is the lab in-network?
Why this code is in our seed set
One of the highest-volume lab tests in men over 50; in the CMS Top 100 Laboratory Procedures Ranked by Services.
Validated against
- •CMS Top 100 Laboratory Procedures Ranked by Services
- •USPSTF Prostate Cancer Screening recommendation
- •AMA CPT code 84153 descriptor
Terms you'll see
The insurer is reviewing whether the service is clinically appropriate for your situation.