US · guidance
CMS Pub. 100-04, ch. 7, § 80.5
Prostate Cancer Screening
Sections 1861(s)(2)(P) and 1861(oo) of the Act (as added by §4103 of the Balanced
Budget Act of 1997), provide for 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 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).
Payment is made under the clinical diagnostic laboratory fee schedule.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5e06ef6afd43a4bba608cb010cd95cd1e5777dacfffadb8e8c6ecb3e71e05b1d
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