Medicare AdvantageCoverageMedium impact
Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
Blue Cross Blue Shield of Rhode Island·RI · Urology, Oncology, Internal Medicine +1 more·Physician / Facility
Effective date
Dec 1, 2018
We identified it
Jun 20, 2026
Summary
The 4Kscore® Test (CPT 81539) for prostate cancer diagnosis and risk assessment is now covered for BlueCHiP Medicare members effective December 1, 2018. The service remains not medically necessary for commercial products with no coverage change.
Action Required
Immediately: Billing team must update system to allow coverage for CPT 81539 (4Kscore Test) for BlueCHiP Medicare patients only. Verify patient insurance type before billing - covered for Medicare but remains non-covered for commercial plans. Update encounter forms and billing rules to reflect this payer-specific coverage difference.