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Prostate Specific Antigen (PSA)

Blue Cross & Blue Shield of Mississippi·MS · Urology, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

This is a comprehensive PSA testing policy that establishes medical necessity criteria for prostate cancer screening and monitoring. The policy requires shared decision-making for screening, limits testing frequency (annually for symptomatic patients, every 2 years for screening), and specifies high-risk categories starting screening at ages 40-45 versus age 50 for average risk.

Action Required

Action needed
Immediately: Review PSA test orders to ensure compliance with frequency limitations - maximum once per year for symptomatic patients, maximum every 2 years for screening. Providers must document shared decision-making discussion for all screening PSA tests. Update EMR templates to capture high-risk factors (Black race, family history under 65, BRCA mutations) and urinary symptoms. Claims may be denied if testing exceeds frequency limits or lacks proper documentation.

Affected Billing Codes

84152
84153
84154
G0103
A18.14
C61
C68.0
C79.19
C79.82
D07.5
D09.19
D29.1
D30.4
D40.0
D41.3
D49.59
F98.0
N02.0
N02.1
N02.2
N02.3
N02.4
N02.5
N02.6
N02.7
N02.8
N02.9
N30.01
N30.11
N30.21
N30.31
N30.41
N30.81
N30.91
N39.3
N39.41
N39.42
N39.43
N39.44
N39.45
N39.46
N39.490
N39.498
N40.0
N40.1
N40.2
N40.3
N41.0
N41.1
N41.2
N41.3
N41.4