Prostate Cancer Screening CPT G0102 and G0103

HCPCS/CPT Codes

G0102 – Prostate cancer screening; digital rectal examination

• The Physician performs a prostate cancer screening in which he performs a digital rectal examination to assess the male patient’s prostate. 
• To examine the prostate the provider inserts a gloved and lubricated finger into the rectum and checks for hardness, lumps, or any abnormalities. 
• This examination helps detect prostate cancer in its early stages. The provider typically performs this test for the first time at the age of 40 for men at risk of having prostate cancer such as those men with a family history of cancer
• Medicare provides coverage for an annual prostate cancer screening digital rectal examination for men at the age of 50.  

G0103 – Prostate cancer screening; prostate specific antigen test (PSA)

• The Prostate screening examination, the Physician detects the prostate specific antigen, or PSA, level in a patient’s blood. PSA is a protein the prostate gland produces, and he/she may use PSA levels to screen for prostate cancer
• This protein is considered as an indicator for prostate cancer. The Physician collects the blood sample through a venipuncture. This test helps to detect prostate cancer in its early stages. 
• A normal level of PSA in blood level as specified below, 
• For below 50 years of age is less than 2.5
• For age 50 to 60 it is less than 3.5, 
• For age 60 to 70 it is less than 4.5 
• For age above 70 it is 6.6.  
• Medicare provides coverage for an annual prostate cancer screening, or PSA, test for men at the age of 50.

ICD-10 Codes

The specified below ICD codes are covered for CPT G0102 and G0103 but may not be limited and some private payers having specific guidelines.

• D07.5 Carcinoma in situ of prostate
• D29.1 Benign neoplasm of prostate
• D40.0 Neoplasm of uncertain behavior of prostate
• R97.20 Elevated prostate specific antigen [PSA]
• R97.21 Rising PSA following treatment for malignant neoplasm of prostate
• Z12.5 Encounter for screening for malignant neoplasm of prostate
• Z15.03 Genetic susceptibility to malignant neoplasm of prostate
• Z71.84 Encounter for health counseling related to travel
• Z80.42 Family history of malignant neoplasm of prostate
• Z85.46 Personal history of malignant neoplasm of prostate

Who Is Covered

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

Frequency

• Annually for covered Medicare beneficiaries
• Medicare Beneficiary Pays

G0102:

• Co-payment/coinsurance applies
• Deductible applies

G0103:

• Co-payment/coinsurance waived
• Deductible waived