Does Medicare Cover a PSA Blood Test?
Navigate Medicare coverage for PSA blood tests. Get clear answers on eligibility and steps to access this vital prostate cancer screening.
A Prostate-Specific Antigen (PSA) blood test measures the level of PSA, a protein produced by prostate cells, in the blood. This test serves as a screening tool to detect prostate cancer early, even before symptoms appear. Elevated PSA levels can indicate prostate cancer, though other conditions like an enlarged or inflamed prostate can also raise PSA levels. It assists healthcare providers in assessing prostate health and guiding further diagnostic steps if necessary.
Medicare Coverage Specifics
Medicare Part B covers the PSA blood test as a preventive screening service. Medicare Part B typically pays 100% of the Medicare-approved amount, so beneficiaries usually have no out-of-pocket costs for the test itself. This full coverage applies because it is classified as a preventive service.
While the PSA test itself is covered at no cost, other related services, such as the office visit, may still be subject to standard Medicare Part B deductibles and coinsurance. Medicare Advantage plans also cover yearly PSA tests, but beneficiaries should check their specific plan details for network requirements or cost variations.
Qualifying for Coverage
Specific criteria must be met for Medicare to cover the PSA test. Medicare covers one annual PSA blood test for men aged 50 and older, provided at least 11 months have passed since the last covered test. Coverage is for screening purposes in asymptomatic individuals.
A doctor’s order is required for Medicare to cover the screening. While age and frequency requirements are firm for routine screening, Medicare may cover additional PSA tests if a healthcare provider determines they are medically necessary for diagnostic or monitoring purposes.
Steps to Receive Covered Testing
Consult with your primary care physician or a urologist to receive a Medicare-covered PSA test. Discuss the benefits and risks of the PSA test and obtain a doctor’s order for the screening. This order is a prerequisite for Medicare coverage.
Once you have a doctor’s order, the test can be performed at a Medicare-approved laboratory or facility. Ensure the provider accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment. The facility will bill Medicare directly, using the appropriate codes for a preventive screening PSA test. Review your Explanation of Benefits (EOB) from Medicare to confirm the test was processed correctly, showing no charge for the PSA test itself.