What test is ordered for Prostate-Specific Antigen (PSA) screening?

PSA Screening Test Ordering Guidelines

For PSA screening, order a regular blood sample test using CPT code 84153 for commercial insurance patients or HCPCS code G0103 for Medicare patients, along with ICD-10 diagnosis code Z12.5 to indicate preventive screening. 1

Test Specifications and Collection

• PSA testing is performed with a standard blood sample, typically drawn at a primary care office or laboratory facility 2
• The test measures the level of prostate-specific antigen, a protein produced by the prostate gland, in the bloodstream 3
• No special preparation is required for the basic PSA test, though certain factors can affect results 3

Pre-Test Considerations

• Advise patients to avoid the following before PSA testing:
  • Vigorous exercise (especially cycling) for 2 days prior to testing, as this may cause false elevations 2
  • Ejaculation for 2 days prior to testing, as this may result in false positive elevation 2
  • Certain medications may affect PSA levels, particularly 5α-reductase inhibitors (finasteride, dutasteride), which can reduce PSA levels by approximately 50% 3

Billing and Documentation Requirements

• For Medicare patients:

  • Use HCPCS code G0103 for screening PSA test 1
  • Annual screening is covered for men age 50 and older with no cost-sharing 1
  • For high-risk patients (African American men or those with family history), document risk factors to support earlier screening at age 45 1

• For commercial insurance patients:

  • Use CPT code 84153 1
  • Include ICD-10 diagnosis code Z12.5 to indicate preventive screening 1
  • For patients with family history of prostate cancer, consider adding code Z80.42 1

Interpretation Considerations

• The traditional PSA threshold of 4.0 ng/mL has been used as a cutoff for prostate cancer suspicion, though significant cancer can occur at lower levels 3
• PSA levels normally increase with age, and age-specific reference ranges may be more appropriate 2
• For patients on 5α-reductase inhibitors, PSA values should be doubled for comparison with normal ranges 3

Special Population Considerations

• African American men have higher baseline PSA levels and may require race-specific reference ranges 4
• For men with family history of prostate cancer or African descent, screening may begin earlier (age 45) 2
• Men with multiple family members diagnosed with prostate cancer before age 65 may begin screening at age 40 2

Limitations and Pitfalls

• PSA is prostate-specific but not cancer-specific; other conditions like benign prostatic hyperplasia and prostatitis can elevate PSA levels 5
• False-negative results can occur in approximately 20-25% of cases, meaning normal PSA levels don't rule out prostate cancer 3, 5
• False-positive results occur in about 65% of cases, potentially leading to unnecessary biopsies 3
• Avoid using diagnostic codes for symptoms when the test is truly for screening purposes, as this may result in incorrect patient cost-sharing 1

Follow-up Recommendations

• For mildly elevated PSA results, consider rechecking in 3-6 months before proceeding to biopsy 3
• Use the same laboratory assay for serial PSA measurements to ensure consistency 3
• For PSA velocity calculations (rate of change over time), at least 3 PSA measurements over 18 months are recommended 3