Does Medicare Cover PSA Screening Tests?
Navigate Medicare's coverage for PSA screening tests. Learn if you're covered, potential costs, and how to access this preventive service.
A Prostate-Specific Antigen (PSA) test is a blood test designed to measure the level of prostate-specific antigen in a man’s blood. This antigen is a protein produced by cells in the prostate gland. Elevated PSA levels can indicate various prostate conditions, including prostate cancer, an enlarged prostate, or an inflamed prostate.
Medicare Coverage Specifics
Medicare provides coverage for prostate cancer screening tests, including the Prostate-Specific Antigen (PSA) blood test. This coverage falls under Medicare Part B, which addresses medical insurance for outpatient care. The PSA test is considered a preventive screening service.
For a PSA test to be covered, specific criteria must be met regarding the beneficiary’s age and the frequency of testing. Medicare covers one PSA blood test once every 12 months for men who have attained age 50. This means that at least 11 months must have passed since the month in which the last Medicare-covered screening PSA test was performed. For example, if a test was performed in January 2025, the next eligible test would be in January 2026.
It is important to note that the test must be ordered by a healthcare professional who deems it medically necessary. This ensures that the screening aligns with established medical guidelines and individual patient needs.
Your Financial Responsibility
For beneficiaries enrolled in Original Medicare Part B, the Prostate-Specific Antigen (PSA) blood test is generally covered as a preventive service with no out-of-pocket costs. This means that for a yearly PSA test, you typically pay nothing if the doctor or other qualified healthcare provider accepts Medicare assignment. Accepting assignment indicates that the provider agrees to accept the Medicare-approved amount as full payment for the service.
The Part B deductible and coinsurance requirements do not apply to the screening PSA test itself. However, if the test leads to further diagnostic procedures, such as an MRI or biopsy due to an elevated PSA level, those subsequent diagnostic services would be subject to the Part B deductible and 20% coinsurance.
Medicare Advantage plans, which are offered by private companies approved by Medicare, must cover at least the same services as Original Medicare, including the annual PSA test. Specific cost-sharing structure, such as copayments or deductibles, may vary depending on the individual plan. Beneficiaries with Medicare Advantage plans should verify their plan’s specific terms and ensure that their healthcare providers and facilities are within the plan’s network to minimize potential costs.
How to Obtain a Covered Test
To obtain a covered Prostate-Specific Antigen (PSA) test, a Medicare beneficiary should first consult with their primary care physician or another qualified healthcare provider. The test must be ordered by a doctor who accepts Medicare assignment.
Once ordered, the PSA test is typically performed as a simple blood draw at a doctor’s office, clinic, or an approved laboratory. It is advisable to confirm that both the ordering provider and the facility where the blood is drawn accept Medicare assignment before the test. This step helps ensure that the beneficiary will not incur out-of-pocket costs for the screening service. The results of the PSA test will then be discussed with the ordering physician, who can provide guidance on any next steps if the levels are elevated or require further evaluation.