Medicare Claims Processing Manual (Pub. 100-04), Ch. 18 § 50
Prostate Cancer Screening Tests and Procedures
50 - Prostate Cancer Screening Tests and Procedures
(Rev. 1, 10-01-03)
B3-4182, A3-3616
Sections 1861(s)(2)(P) and 1861(oo) of the Act (as added by §4103 of the Balanced Budget Act of
1997), provide for Medicare Part B coverage of certain prostate cancer screening tests subject to
certain coverage, frequency, and payment limitations. Effective for services furnished on or after
January 1, 2000, Medicare Part B covers prostate cancer screening tests/procedures for the early
detection of prostate cancer. Coverage of prostate cancer screening tests includes the following
procedures furnished to an individual for the early detection of prostate cancer:
•
Screening digital rectal examination, and
•
Screening prostate specific antigen (PSA) blood test.
Each test may be paid at a frequency of once every 12 months for men who have attained age 50
(i.e., starting at least one day after they have attained age 50), if at least 11 months have passed
following the month in which the last Medicare-covered screening digital rectal examination was
performed (for digital rectal exams) or PSA test was performed (for PSA tests).